Inge Kowanko

Selection of continence products: perspectives of people who have incontinence and their carers.

Purpose : The needs, issues and concerns of people with incontinence and their carers were explored in order to inform the development of a comprehensive Australian consumer guide to continence products. Participants and methods : Semi-structured interviews and focus groups were conducted with a wide range of people with incontinence and carers. Questions centred around issues and concerns regarding continence product selection, what information people need to make informed choices, and how the information should be presented. Qualitative analysis highlighted common themes and specific issues. Results : Issues raised by consumers included the paucity of written information currently available, ignorance among health professionals concerning continence products and the lack of information about sources of help. Most consumers selected products by trial and error and were unaware of the range of products and services available. They wanted a consumer guide to continence products to be user-friendly and easily accessible, with information on product availability, cost, quality, comfort and design. They also wanted more general information on incontinence, sources of help, and how to select, care for and dispose of products. Participants wanted the guide to be made available in different languages, in large print and simple language. Conclusions : The findings highlight the need and provide a framework for a consumer guide and information on continence products.

Improving coordination of care for Aboriginal people with mental health, alcohol and drug use problems: progress report on an ongoing collaborative action research project

This paper outlines the background and progress to date of a project to improve the coordination of care for Aboriginal people with mental health and/or alcohol and other drug problems living in the Eyre Peninsula region of South Australia. The project responds to recommendations from previous research by this team in this area, and has been running since 2004. Working with a wide range of health and human service providers, we explored issues that improve or hinder coordination of care and identified useful strategies. Some of these have already been implemented through the project: e.g. interagency cross-disciplinary training in response to shared needs, and lobbying for after-hours telephone help. Other strategies are still in progress: e.g. implementing a uniform triage and referral system and improving information sharing within Port Lincoln Aboriginal Health Service. The paper reflects on our experience of conducting Aboriginal health service research using a participatory action oriented approach, and discusses the challenges in providing effective and well coordinated rural and remote mental health/alcohol and other drug care in the context of complex health and social needs of Aboriginal people.

Chronic condition management and self-management in Aboriginal communities in South Australia: Outcomes of a longitudinal study

OBJECTIVES This paper describes the longitudinal component of a larger mixed methods study into the processes and outcomes of chronic condition management and self-management strategies implemented in three Aboriginal communities in South Australia. The study was designed to document the connection between the application of structured systems of care for Aboriginal people and their longer-term health status. METHODS The study concentrated on three diverse Aboriginal communities in South Australia; the Port Lincoln Aboriginal Health Service, the Riverland community, and Nunkuwarrin Yunti Aboriginal Health Service in the Adelaide metropolitan area. Repeated-measure clinical data were collected for individual participants using a range of clinical indicators for diabetes (type 1 and 2) and related chronic conditions. Clinical data were analysed using random effects modelling techniques with changes in key clinical indicators being modelled at both the individual and group levels. RESULTS Where care planning has been in place longer than in other sites overall improvements were noted in BMI, cholesterol (high density and low density lipids) and HbA1c. These results indicate that for Aboriginal patients with complex chronic conditions, participation in and adherence to structured care planning and self-management strategies can contribute to improved overall health status and health outcomes. CONCLUSIONS The outcomes reported here represent an initial and important step in quantifying the health benefits that can accrue for Aboriginal people living with complex chronic conditions such as diabetes, heart disease and respiratory disease. The study highlights the benefits of developing long-term working relationships with Aboriginal communities as a basis for conducting effective collaborative health research programs. WHAT IS KNOWN ABOUT THE TOPIC? Chronic condition management and self-management programs have been available to Aboriginal people in a range of forms for some time. We know that some groups of patients are keen to engage with care planning and self-management protocols and we have anecdotal evidence of this engagement leading to improved quality of life and health outcomes for Aboriginal people. WHAT DOES THIS PAPER ADD? This paper provides early evidence of sustained improvement over time for a cohort of Aboriginal people who are learning to deal with a range of chronic illnesses through accessing structured systems of support and care. WHAT ARE THE IMPLICATIONS FOR PRACTITIONERS? This longitudinal evidence of improved outcomes for Aboriginal people is encouraging and should lead on to more definitive studies of outcomes accruing for people engaged in structured systems of care. Not only does this finding have implications for the overall management of chronic illness in Aboriginal communities, but it points the way to how health services might best invest their resources and efforts to improve the health status of people with chronic conditions and, in the process, close the gap between the life expectancy of Aboriginal people and that of other community groups in Australia.

Improving Indigenous health through better medication management: an overview

This paper provides an overview of a major South Australian research project with implications for the health of all Indigenous Australians. The researchers set out to explore the medication needs of Aboriginal people with mental health problems and found that most Aboriginal people have to deal with profound challenges to social and emotional wellbeing with significant medication implications. No previous research had investigated the problem of medication use by Aboriginal people in metropolitan, rural and remote locations to the depth and extent of this project. The research therefore is of widespread relevance and holds interest for many Indigenous and non-Indigenous individuals and groups, consumers, service providers and policy-makers. As a research team comprising Indigenous and non-Indigenous members, we were committed to implementing strategies in the course of the project with immediate benefit to project participants as well as longer-term impact on improved use of medications. The design of the project enabled these strategic interventions and we are pleased to promote this model to other researchers. Recommendations from the project concern services, coordination of care, carers and family members, workforce education, and community development. Readers are advised where the project report and other published papers can be accessed. The project was funded by the Commonwealth Department of Health and Ageing.