A PROJECT PLAN FOR MANAGEMENT OF TYPE 2 DIABETES IN AUSTRALIAN RURAL AND REMOTE AREAS
The problem of chronic illness is increasing swiftly in Australia. Type-2 diabetes (T2D) has recently presented alarming prevalence in the Australian population that challenges the effort of establishing a healthy Nation. The increased prevalence of the type-2 diabetes within the Australian’s indigenous youths and the disproportionate distribution of the disease prompted the establishment of this project. This is because the scenario creates the need of developing a strategic plan that would inform management of type-2 diabetes within the indigenous young individuals especially the ones living in Australian’s rural areas. This subject is important to the health of the target group and the entire Australians because it will enable healthcare providers and policy makers identify essential areas that the primary health care interventions should emphasize (Sealey, Sinclair, Pollock, & Anne-Marie, 2010 p. 34). This would promote the management of the type-2 diabetes within the target group that would improve the health status in the entire community. The project concentrates in the manifestation of the T2D in young indigenous Australians inhabiting the rural and remote areas. The study explores theoretical frameworks relevant to the management of T2D in order to establish broad knowledge about the subject. Particularly, the project explores the possibly of applying the concept of self-management in reducing the prevalence of the disease. Furthermore, the project examines the multiple risks factors associated with the management of T2D in the context of the target population and its environment. This is with the intention of designing a customized plan that would foster management of the presented healthcare problem.
It is apparent that management of chronic diseases is a serious health challenge in Australia. Studies account that in Australia, about 65% of the total serious health concerns are attributable to chronic diseases such diabetes, cardiovascular disease, asthma, cancers and renal complications among others (Perrin et al., 2012). Particularly, T2D is currently presenting terrifying establishment rates. Type-2 diabetes is a chronic state that is associated with unmanageable levels of sugar in the body. This blood condition happens when the body fails to generate enough insulin that is vital for the management of blood’s sugar levels. Surprisingly, health records indicate that 88% of diabetes patients have T2D diabetes. Furthermore, Tabrizi, Wilson, Coyne & O’Rourke (2008) states that about one million Australian were diagnosed with type-2 diabetes in the year 2001. Earlier, physicians identified diabetes type-2 diabetes as an adult-onset condition. However, current studies establish that the prevalence of type-diabetes is increasing extensively in young people including children and adolescents (Andreasyan, Hoy & Kondalsamy-Chennakesavan, 2007 p. 423).
According to Perrin, et al. (2012), indigenous Australians have presented inexplicable high rate of T2D in the last few decades. An outstanding pattern highlighted by recent epidemic records present the increased risk among individuals in remote settings and early age of onset. Although the available data about the disease is limited, it is apparent that the T2D among indigenous juveniles is increasing and its burden in this group is considerably higher than the one recorded in non-indigenous young individuals. Indigenous juveniles with T2D often present a family history of the disease, and are overweight and may have signs of hyperinsulinism. Onset of T2D mainly happens during earlier adolescence and the victims tend to be asymptomatic at presentation. Various records including the data from the United States have confirmed this scenario. Statistics explaining the co-morbidities of the condition at diagnosis are lacking. Nevertheless, the incidence of micro-vascular and macro-vascular problems and mortality related to T2D within the population of Indigenous young individuals is notable.
It is worthwhile affirming that determinants of the increased risk of T2D in juveniles are sophisticated. Some scholars argue that intrauterine exposures that may comprise diabetes during pregnancy have the potential of interfering with the expression of genes that are related to carbohydrate metabolism. Interestingly, studies have confirmed that gestational diabetes is common among indigenous mothers and physically inactive individuals. This means that genetic predisposition and social-economic conditions play a vital role in defining the prevalence of the disease. Perrin, et al. (2012) argues that a diabetic condition especially during childhood is associated with severe implications for the juveniles, their family and the entire community. This means that the condition is capable of straining health system and affecting the development trajectory of youths negatively. Consequently, Perrin, et al. (2012) argues that the Australian healthcare procedures face a severe challenge of addressing the increasing number of the youths with T2D especially among rural residents.
Studies examining the distribution of type-2 diabetes within the Australian population highlights that the prevalence of the disease is high among the indigenous groups and in the rural areas (Bergin, Brand, Colman & Campbell, 2009). Mortality rates related to diabetes are double in the remote areas than in Australian’s metropolitan. Lau et al. (2012) study on the demographics of the T2D indicates that the prevalence of diabetes among native and Torres Strait Islander individuals is 6% with those dwelling in remote areas presenting higher rates of about 9%. This is in contrast to their city counterparts who recorded a prevalence rate of about 5%. Further analysis indicated that the natives were three times more likely to present diabetic conditions when compared to non-indigenous. Andreasyan, Hoy & Kondalsamy-Chennakesavan (2007) identifies that female living in Australia’s rural areas are 1.3 times likely to record diabetes than the ones living in the urban areas. However, rural males have low chances of reporting the condition. Furthermore, admission rates for T2D are two times higher in rural areas than in urban areas.
According to Bergin, Brand, Colman, & Campbell (2009 p. 672), the high burden of the condition in rural setups is attributable to “social determinants” of health. This regards to the situation in which people live and work. Harvey et al. (2008) study highlights that inhabitant of Australia’s remote areas present low socioeconomic status. This is associated with increased health risks factors and deteriorated health outcomes. Further surveys assert that rural residents are characterized with higher levels of definite lifestyle-related risk factor for diabetes than city dwellers. Prevalence of T2D is affected by multiple risk factors that include age, ethnicity and genetic attributes. Furthermore, aspects like poor nutrition, lack of physical activity. Smoking and poor weigh management play a vital role in the development of a diabetic condition. Interestingly, Grist (2008) affirms that rural residents have high chances of smoking, eating inadequate fruits and being obese.
Understanding influential challenges in establishing effective health care delivery procedures in rural areas is essential in designing strategic interventions. According to Butler, Petterson, Bazemore & Douglas (2010 p. 201), the major factor affecting management of diabetes in rural areas includes limited resources at personal, community and institution levels. For example, socioeconomic disadvantages limit opportunities for accessing healthcare. Furthermore, health systems mainly emphasize on handling high risks of chronic diseases in adults while ignoring young subpopulation. Lau et al. (2012 p. 68) argues that the combination of these factors result in inadequate follow-up for indigenous young people who have T2D. Poor management of conditions such as persistent hyperglycemia, poor administration of insulin therapy and limited screening enhances the development of the disease.
Harvey et al. (2008) report highlights that rural dwellers experience poorer access to preventive and acute health services because of shortages of the health professionals needed for early detection and management of the disease. Particularly, the limited number of professionals such as podiatrists, dietitians, optometrists and diabetes specialists has challenged the management of the T2D within the rural residents. Furthermore, the rural community has limited access to community infrastructure and health promoting facilities. This includes limited access to fresh foods, healthy workplaces, recreation facilities and other health promoting elements of the built environment (Smith, et al., 2010 p. 889).
Various studies have examined efficiency of diverse strategies in the management of T2D in the rural setups. Grist (2008) argues that that some lifestyle modification strategies are successful in primary healthcare environments in rural and remote areas. This position is supported by the idea that community’s lifestyle plays a significant role in the development and management of T2D. Strategic studies argue that care for the patients who have chronic conditions should involve multiple health care providers working in multiple settings. These studies indicate that an integrated system and collaborative interventions are essential in establishing a healthy environment. This demands commitment from patient, healthcare providers and agencies to work together in attaining shared goals. Butler, Petterson, Bazemore & Douglas (2010) supports the need of designing strategies that would foster modification of lifestyles in a manner that would promote self-management interventions. Self-management entails making people participate actively in their health care. This strategy is supported by various principles and is acknowledged by Commonwealth as a vital component of diabetes management. Other informed studies support the need of designing interventions that target reducing poverty and unemployment and improving the social-economic status of the rural residents by providing them with essential facilities and infrastructure (Harvey et al., 2008 p. 334).
There is need of establishing effective health care strategies that would reduce the burden of the T2D among the rural residents. The problem of T2D diabetes is pronounced within the indigenous Australians who reside in remote areas. The literature review indicates that the main cause of the problem includes the rural areas’ poor social-economic status. This predisposes the rural residents to risky habits and unhealthy environment that encourage the development of the disease. Furthermore, such status leads to a situation of inadequate resources that interfere with the management of the condition. For example, limited healthcare professionals and infrastructure discourage strategies of early detection and follow-up that are vital in the management of the disease (Sealey, Sinclair, Pollock, & Anne-Marie, 2010). The problem of T2D mainly occurs when individuals are exposed to predisposing environments and are involved in activities that foster the establishment of the disease. However, the disease often has genetic background that makes a particular group present high prevalence than others. The problem of T2D occurs in diverse setups including in populations of all races, classes, gender and different age groups. However, as affirmed by various studies, the severity of the problem differs extensively and the indigenous Australians residing in rural areas present the highest rates.
The major effects of high prevalence of T2D include the low living standards and reduced life expectancy. The general objective of this project includes designing a plan that utilizes effective strategies in the management of T2D in order to reduce its prevalence among the indigenous including the Australians youths particularly the one living in rural areas. The specific objective of the project includes reducing the prevalence of T2D in indigenous children and adolescents living in Australia’ rural from 80% to 20% in five years. This is essential in ensuring a healthy wellbeing of the entire Australian population.
Project Design and Implementation
The project will be structured into various implementation stages that includes the promotion, execution and monitoring. The initial phase includes the promotion of the project that run for about five months. This stage aims at marketing and popularizing the project to the stakeholders who are essential for successful implementation of the project. Consequently, the project managers will access prominent healthcare administrators, policy makers, agencies and the target community in order to lure them into embracing the project’s ideologies. This stage will be essential in ensuring that the project has obtained financial support and approval from relevant authorities.
The second phase includes the execution of the project’s strategies. The project will initiate by applying its proposals to the most vulnerable populations. The most active period of the implementation stage is expected to last for about a year. Execution of the project will include joint efforts where healthcare providers, agencies, governments and the community will participate actively in practicing the project’s interventions. Furthermore, multi-dimensional interventions will be utilized in the management of the condition; however, the project will emphasize lifestyle modification strategy by popularizing the concept of self-management. An effective strategy for managing the disease is ensuring that there is frequent screening for T2D for any indigenous individual aged more than 10 years who presents sign for the disease (Smith et al., 2010). Individualized management strategies will include identification of risk factors, behavioral factors, treatments targets and psychosocial factors that may affect disease management procedures. The final stage includes a progressive monitoring of the performance of the project in order to establish areas that need improvements and propose essential adjustments to the project. This will run for the entire project’s time and will eventually describe the success of the plan attaining its objectives.
Expected Outcomes and Evaluation
The project is expected to attain its objectives within the proposed five-year term. The project will have a special team whose main role is evaluating the performance of the project. Initially, the major healthcare institutions in the region will be provided with data collecting manuals for recording essential important regarding the disease. The evaluation team will be collecting these manuals on monthly bases and compile them in order to draw descriptive statistics about the prevalence of the T2D in the region. Furthermore, the team will be conducting frequent surveys to examine the compliance to the project’s proposals both in private and public healthcare institutions. These surveys will also evaluate the commitment of the society in embracing self-management approaches. Project managers will utilize all data obtained from these sources in quantifying the performance of the project.
Dissemination of project’s findings is an important aspect to account for when designing a disease management plan because it affects the acceptability and adoption of the plan (Tabrizi, Wilson, Coyne & O’Rourke, 2008). The major dissemination plan of the findings of this project includes persuasive advocacy and enlightenments. This plan targets establishing support and adoption the project’s interventions. Initially, the project promoters will explain to the relevant stakeholders the urgent need of addressing the problem of T2D among the rural residents. This will include making the stakeholders understand the alarming rates of the prevalence of T2D in target population. The project will further describe how high prevalence of T2D affects health promotion strategies and the entire Australian population. After the stakeholders have acknowledge the idea of responding to the problem of high rates of T2D in the target group, the project managers will explain the capability of this plan in responding to the problem. This will include explain to the stakeholders the rationale, the objectives, the reliability and efficiency of the project tools in attaining its objectives. The implementation team will also conduct extensive campaigns that will target healthcare institutions and the community in order to popularize the project’s strategies. With persuasive promotion, the project’s interventions are likely to reach the target group.
Successful adoption of the project will have various implications to healthcare providers, consumers, and the entire Australian health system. Initially, health care providers may need to undergo special frequent training that would empower them with new skills for managing the condition. This is because realization of the project’s objectives demands skilled professional who understands the challenges associated with the management of T2D and the available alternatives for addressing such concerns. For example, studies identified that early detection would be effective in the management the condition (Tabrizi, Wilson, Coyne & O’Rourke, 2008). This means care that providers should have skills for detecting the disease even when the condition is at asymptomatic stage. Furthermore, the project may demand consumers to adjust their lifestyles. As identified, this project emphasizes lifestyle modification as a strategic approach for managing T2D. This means that consumers are obliged to abandon the predisposing habits and assume behaviors that promote healthy living. The project will also affect the organization and the fiscal patterns of the Australian health system. This is because the system must prioritize the project’s interventions that may lead to adjustment of system’s strategies. For example, the Australian health system will be obliged to increase its budgetary allocation especially for the promotion of primary healthcare in rural areas.
The study indicates the crucial importance of adopting a project that would enhance management of T2D among indigenous children residing in Australian rural. It is apparent that the high prevalence of the T2D recorded by this particular population demand urgent corrective measures. Through literature review, this study has established informed concepts regarding the prevalence and management of T2D in the target group. Furthermore, the study has established a strategic plan that has the potential of addressing the problem. Successful adoption of this project will reduce the incidence of T2D in indigenous individuals living in rural areas considerably. Implementation of the project may be challenging; however, with communal effort and high dedication, the project can achieve its objectives. Furthermore, adoption of the project may be costly, but this a worthy project considering its potential in building a healthy nation. Adoption of the project may also be associated with various implications. However, stakeholders should not worry of such implications because they are all happening for the benefit of the entire Australian population. This is because successful implementation of the program will improve the community’s living standards and reduce suffering and wastage of resources. Consequently, the government, healthy institution, relevant agencies and the entre society should present a high degree of commitment towards successful adoption of this project.
Andreasyan, K, Hoy, W, & Kondalsamy-Chennakesavan, S 2007, ‘Indigenous mortality in remote Queensland, Australia’, Australian & New Zealand Journal of Public Health, 31, 5, pp. 422-427, Business Source Complete, EBSCOhost, viewed 14 January 2013.
Bergin, S.M., Brand, C.A., Colman, P.G. & Campbell, D.A. 2009, “An evaluation of community-based resources for management of diabetes-related foot disorders in an Australian population”, Australian Health Review, vol. 33, no. 4, pp. 671-8.
Butler, D, Petterson, S, Bazemore, A, & Douglas, K 2010, ‘Use of measures of socioeconomic deprivation in planning primary health care workforce and defining health care need in Australia’, Australian Journal Of Rural Health, 18, 5, pp. 199-204, Academic Search Premier, EBSCOhost, viewed 14 January 2013.
Grist, J. 2008, “Diabetes under assault”, Australian Doctor, pp. 39-n/a.
Harvey, P.W., et al. 2008, “Self-management support and training for patients with chronic and complex conditions improves health-related behaviour and health outcomes”, Australian Health Review, vol. 32, no. 2, pp. 330-8.
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Perrin, et al. (2012) “An organised approach to the podiatric care of people with diabetes in regional Australia”, Australian Health Review, vol. 36, no. 1, pp. 16-21.
Sealey, R.M., Sinclair, W.H., Pollock, P. & Anne-Marie Wright 2010, “A case study identifying disease risk factor prevalence in government office workers in Queensland, Australia”, International Journal of Workplace Health Management, vol. 3, no. 1, pp. 34-43.
Smith, K, et al. 2010, ‘Factors associated with dementia in Aboriginal Australians’, Australian & New Zealand Journal Of Psychiatry, 44, 10, pp. 888-893, Academic Search Premier, EBSCOhost, viewed 14 January 2013.
Tabrizi, J.S., Wilson, A.J., Coyne, E.T. & O’Rourke, P.,K. 2008, “Review of patient-reported type 2 diabetes service quality”, Australian Health Review, vol. 32, no. 1, pp. 23-33.
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