Do Indigenous health workers improve chronic care for high risk adults in remote communities

Prevalence of diabetes and complex chronic conditions is greater, and complications higher for Indigenous people living in remote communities than the general Australian population. Outcomes can be improved greatly with appropriate primary care which includes local Indigenous health workers (IHWs) as key members of the team. IHWs provide language and cultural brokerage between non-Indigenous staff and clients that supports effective self-management. We undertook a trial of a model of diabetes care where IHWs received training and ongoing support for clinical diabetes and chronic disease management in 12 remote communities. We devised a mixed methods evaluation of clinical outcomes, care processes and implementation fidelity. The trial was modestly successful in in1proving clinical outcomes and reducing complications requiring hospital care. However implementation of the model of care was compromised by major health service restructure and a lack of systems in some services to appropriately accommodate the IHWs as key care coordinators. We conclude that the trial showed that IHWs contributed to improved outcomes in these settings despite these barriers, and that services and other health team members would benefit from a better understanding of the unique cultural and professional role of these workers if the best outcomes are to be achieved.