Abstract:

Pilot programme preliminary results for a shared care approach to asthma management in a small rural Indigenous community.

Logan-Sinclair, P & Gunter, R.

Objective/Purpose:

A shared care programme was piloted in the rural NSW township of Gulargambone, in consultation with the Indigenous community, to reduce acute presentations and complications for asthma at hospital by improving asthma management.

Project Outline:

Gulargambone, situated 116km north of Dubbo, has an Indigenous population of approximately 172 people. The area health service identified asthma complications for hospital presentations in 20.4% of cases, with 45% of all presentations being Aboriginal. Although Gulargambone has a small community hospital, general practitioners visit but do not reside in the town. Pharmacy and Ambulance services are 40km distant. Isolation hence restricts levels of patient care. The shared care model improves communication between all stakeholders within and distant from the town, providing an educational and monitoring system for better asthma management and resource usage.

The shared care model for asthma management is built upon conscientious liaisons between G.P.s, local nurses, asthma education officers, Aboriginal Health Workers, and the local Aboriginal community. The model is based upon accepted education designs, however, in consultation with the local Aboriginal community cultural adaptations were made to encourage participation who up to this point had not been effectively accessing health services as reflected by the hospital presentation statistics.

Method:

Effectiveness of the programme is being monitored using Quality of Life (QOL) and Asthma Knowledge questionnaires to assess individual participants progress at 6 and then 12 months. Initial testing preceeded the educational programme so that measures of difference in response could be measured. The questionnaires were adapted from tested and validated designs in consultation with the Aboriginal community. The adapted questionnaires are delivered and recorded by interview avoiding potential literacy problems. Spirometry is used in those over 6 years of age providing a quantitative measure of management. An Aboriginal Health Worker assists in test delivery facilitating better understanding.

This report concerns the results after 6 months of operation of the programme.

Results:

23 Aboriginal people have enrolled in the programme, 12 of whom have completed the questionnaires at 6 months after commencement. 12 children under 10years and 4 infants are participating with their mothers. 11 are female, 12 male.

Questionnaire results indicate:

an overall improvement of knowledge for all bar one participant;

a positive improvement of 24% for questions regarding breathlessness;

a positive improvement of 25% for questions regarding mood disturbance;

a positive improvement of 17% for questions regarding social disruption;

a positive improvement of 40% for questions regarding concerns for health.

Individual participants recorded changes in QOL such that:

5 participants moderate symptoms shifted to no symptoms;

1 participant’s severe symptoms shifted towards mild symptoms for 27% of the QOL questions;

non significant shifts occurred for 5 participants whose original symptoms were recorded as mild to very mild.

Discussion:

The sample population demographics reveal a lack of participants in the teenage – young adult age group yet based on known population numbers the enrolment by the Aboriginal community is high. All except one of the 12 participants completing the 6 month testing indicate improvement in some areas of symptom control. Those that did not retest at 6 months will hopefully be retested at 12 months. Being a small township the researchers are aware of unavoidable cultural commitments, parental illness and relocation as being reasons for those not retesting. Strategies to encourage the young adult and teenage groups of the community are currently being initiated

Conclusions:

A documented culturally adapted programme now exists for testing on a larger scale to determine how successfully it may be implemented in disparate Aboriginal communities.