Clinical management of diabetes and alcohol-related health problems

The aim of this project was to meet a need stated by Aboriginal health workers (AHWs) across South Australia for accurate, coordinated processes that produced quality outcomes for Aboriginal people with co-existing diabetes and alcohol-related health problems. Information on any current protocols and clinical pathway data were sought from health service providers that served this large client group across SA. To understand the issues involved, the published literature was searched to provide a context to the problem, an insight into the current processes in each of the disease areas, and how these were being implemented. Discussion and recommendations focused on ways service providers and AHWs’ learning needs may be met so that AHWs and other health professionals are better prepared to manage their clients’ needs.

The project found that:

• No one model of management will work across the entire Aboriginal population as the lifestyle of urban Aboriginal people differs to those living in remote areas.
• Diabetes is not necessarily considered a health issue in many peoples’ lives until it reaches a crisis point, and coherent case management takes time to implement, so early referral to appropriate Aboriginal and other health professionals is essential.
• There is a need to coordinate the areas of diabetes, mental health and substance misuse care into one comprehensive and flexible management plan.
• The direct resourcing of management plans that address multiple comorbidities in Indigenous client groups could improve coordination and build capacity across psychiatric / mental health services, general medical services, drug treatment services, and Aboriginal health services. Direct resourcing also opens up the possibility of developing best practice guidelines that facilitate service delivery, and improving professional education and training for AHWs and mainstream professionals.

A sample of 47 Aboriginal and non-Aboriginal health services throughout SA were invited to provide information on diabetes and alcohol-related disease comorbidity among Aboriginal clients. A literature search was also undertaken focused on materials relevant to the Aboriginal client group, and the latest evidence-based clinical management pathways available for use for both disease areas and their comorbid management.