• Ross S Bailie, Damin Si, Gary W Robinson, Samantha J Togni, and Peter H N D'Abbs.
• Menzies School of Health Research, PO Box 41096, Casuarina, NT 0811, Australia. rossb@menzies.edu.au
• Med. J. Aust. 2004 Aug 16; 181 (4): 195200195-200.

ObjectiveTo examine the trends in processes of diabetes care and in participant outcomes after an intervention in two remote regions of Australia.DesignFollow-up study over 3 years.SettingSeven health centres in the Tiwi Islands and the Katherine West region of the Northern Territory.Participants137 Aboriginal people with type 2 diabetes.InterventionImplementation of a multifaceted trial, including transfer of purchasing and planning responsibility to local health boards, the development and dissemination of clinical guidelines supported by electronic registers, recall and reminder systems and associated staff training, and audit and feedback.Main Outcome MeasuresTrends in the proportion of Aboriginal people receiving services in accordance with clinical guidelines and in the proportion for whom specified levels of blood pressure and glycosylated haemoglobin (HbA(1c)) were achieved; health staff perceptions of barriers to effective service delivery.ResultsAn initial improvement in overall service levels from 40% to 49% was not fully sustained over the 3-year period. The overall proportion of services delivered varied from 22% to 64% between communities and over time. The proportion of participants whose most recent HbA(1c) level was less than 7% improved from 19% to 32%, but there was little change in blood pressure control. Perceived barriers to service delivery included discontinuities in staffing, lack of work-practice support and patients' acceptance of services.ConclusionsMultifaceted interventions can improve quality of care in this environment, but achieving sustainable, high-quality care in a range of services and local conditions presents particular challenges. Developing and testing strategies for consistent and sustained improvement should be a priority for service providers and researchers.

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