Setting up chronic disease programs: perspectives from Aboriginal Australia.
OBJECTIVE
To share some perspectives on setting up programs to improve management of hypertension, renal disease, and diabetes in high-risk populations, derived from experience in remote Australian Aboriginal settings.


BACKGROUND
Regular integrated checks for chronic disease and their risk factors and appropriate treatment are essential elements of regular adult health care. Programs should be run by local health workers, following algorithms for testing and treatment, with back up from nurses. Constant evaluation is essential. COMPONENTS: Theses include testing, treatment, education for individuals and communities, skills and career development for staff, ongoing evaluation, program modification, and advocacy. Target groups, elements, and frequency of testing, as well as the reagents and treatment modalities must be designed for local circumstances, which include disease burden and impact, competing priorities, and available resources. Pilot surveys or record reviews can define target groups and conditions. Opportunistic testing will suffice if people are seen with some regularity for other conditions; otherwise, systematic screening is needed, preferably embedded in primary care streams. The chief goal of treatment is to lower blood pressure, and if the patient is diabetic, to control hyperglycemia. Many people will need multiple drugs for many years.


CONCLUSIONS
Challenges include lack of resources, competing demands of acute care, the burden of treatment when disease rates are high, problems with information systems, and in our setting, health worker absenteeism.


BACKGROUND
Businesses, altruistic organizations, and pharmaceutical and biotechnology companies might fund feasibility studies. Where governments or insurance companies already support health services, they must ultimately commit to chronic disease services over the long- term. Effective advocacy requires the presentation of an integrated view of chronic disease and a single cross-disciplinary program for its containment. Arguments based on preserving the economic base of societies by preventing or delaying premature death will carry most weight, as will the costs of dialysis avoided in countries that already support open-access programs.
Hoy
Wendy E
WE
Centre for Chronic Disease, Discipline of Medicine, University of Queensland, Royal Brisbane Hospital, Herston 4029, Australia. w.hoy@mailbox.uq.edu.au
Kondalsamy-Chennakesavan
S
S
Smith
J
J
Sharma
S
S
Davey
R
R
Gokel
G
G
D000328:Adult; D001315:Australia; D002908:Chronic Disease / Q000628:therapy*; D003159:Community-Institutional Relations; D019468:Disease Management; D005380:Financing, Government; D006303:Health Services, Indigenous / Q000458:organization & administration*; D006801:Humans; D008403:Mass Screening / Q000458:organization & administration; D008875:Middle Aged; D011314:Preventive Health Services / Q000458:organization & administration*