Associate Professor Graeme Maguire
Executive Director, Baker IDI Central Australia
Margaret Ross Chair in Indigenous Health
Phone: +61 8 8959 0111
Fax: +61 8 8952 1557
W & E Rubuntja Research & Medical Education Building
Alice Springs Hospital
Gap Road, Alice Springs NT 0870
PO Box 1294, Alice Springs NT 0871
Baker IDI Heart and Diabetes Institute is an independent, internationally renowned medical research facility with a central office located in Melbourne.
Baker IDI Central Australia, located in Alice Springs, was founded in 2007 becoming the second health and medical research institute to be located in the Northern Territory and the first in Central Australia. This Institute was established to help address the profound disadvantage experienced by Aboriginal people in central Australia and throughout the Northern Territory through scientific research that is rigorous, culturally appropriate and ethically sound. While we focus on the needs of people in the NT our expertise in research spans many other jurisdictions and enables contributions in Aboriginal and Torres Strait Islander health spanning from major cities to the most remote communities in Australia and collaborations which address global indigenous health more generally. Whilst Baker IDI Central Australia is the natural focus for implementing our Indigenous health program, our work in this area encompasses all of Baker IDI where we aim to facilitate productive links and collaborations to undertake research relevant to Indigenous health throughout the entire institute.
We are dedicated to carrying out collaborative research projects that build much needed knowledge and that provide practical contributions to Aboriginal and Torres Strait Islander peoples' health. While research is our main business, we are much more than a collection of research projects.
As a clinical service provider, we also provide outreach health services to remote communities and Alice Springs Hospital in order to improve access to specialist care and provide leadership in health service development. In the way we do our business, we are dedicated to supporting capacity building within the communities and organisations we work with, as well as our own staff's development. We are passionate about using our skills and expertise to learn more about Aboriginal and Torres Strait Islander health and to contribute to better health outcomes. The depth of our commitment is what defines Baker IDI's Indigenous health program and our Central Australia institute.
Whilst we concentrate on kidney disease, heart disease and diabetes our Indigenous health program is responsive to the priorities of Aboriginal and Torres Strait Islander people and as such extends to other areas encompassing other chronic and infectious diseases and underlying determinants of health. Baker IDI's Indigenous health program is conducted in close consultation with local communities, working with existing community services to improve the health of Indigenous people when it comes to chronic disease.
Baker IDI's Indigenous health program is committed to ensuring the health of Indigenous Australians, wherever possible, rests in the hands of Aboriginal and Torres Strait Islander people. Our ‘way of doing business' includes working with and empowering Indigenous community-controlled organisations. In addition we have a focus on facilitating employment and capacity building of Aboriginal and Torres Strait Islander people within our organisation.
The Baker IDI Central Australia Strategic Plan 2013 - 2016 can be accessed here.
The vision of Baker IDI Central Australia and our Indigenous health program is:
To support health equity for Aboriginal and Torres Strait Islander people, particularly residents of Central Australia, by reducing the risk and impact of non-communicable and communicable diseases that contribute to the significant gap in life expectancy between Aboriginal and Torres Strait Islander people and other Australians.
Our mission is:
To reduce death disability and illness caused by non-communicable and communicable disease amongst Aboriginal and Torres Strait Islander peoples with a particular focus on the residents of Central Australia.
We aim to achieve our vision and mission by conducting work across four complementary streams including:
Baker IDI's Indigenous health program encompasses abroad range of projects. These include projects where Baker IDI is the lead organisation/administering institution and a large number of collaborative projects linking Baker IDI's Indigenous health program with other Australian research organisations including the University of NSW, James Cook University, Menzies School of Health Research and University of WA.
Examples of Indigenous health projects currently being led by Baker IDI are listed below.
Lead: Graeme Maguire
The Rheumatic Fever Follow Up Study (RhFFUS) is a collaboration between Baker IDI Central Australia and Menzies School of Health Research, James Cook University, and the University of Western Australia. Following on the earlier gECHO (getting Every Child's Heart Okay) study, RhFFUS seeks to determine if children identified with minor heart abnormalities are at greater risk of rheumatic heart disease (RHD) or contracting acute rheumatic fever (ARF). Understanding these changes is vital given that remote Aboriginal communities in these regions have among the highest rates of RHD and ARF in the world.
The RhFFUS project is being conducted in 18 remote Indigenous communities across Queensland, WA and the NT. Echocardiograms will be taken in remote communities with the identified children, with a second trip being made to all communities to disseminate and discuss results.
The findings of RhFFUS will help inform the future response to RHD at the study sites and other settings. In particular, it will allow primary health care providers (nurses, health workers and GPs) and specialists to understand the significance of subtle changes on echocardiography and to determine whether these represent the earliest changes of RHD or simply variations of normal heart anatomy. If children with an initial abnormal echocardiogram are shown to have an increased risk of ARF and/or progression to RHD, it is possible to use earlier screening echocardiography as a first step to prevent the development of RHD.
Lead: Alex Brown
The Kanyini Vascular Collaboration (KVC) received initial funding for five years from the National Health & Medical Research Council (NHMRC) Health Services Research Program to conduct research within Aboriginal communities across the Northern Territory, Western Australia, New South Wales and Queensland. The KVC has received further funding through the Australian Primary Health Care Research Institute (APHCRI) to establish a Centre of Research Excellence (CRE) in Indigenous primary health care intervention research in chronic disease (2011-2014) to continue our program of work into chronic disease. Click here to find out more about the collaboration and the KVC Centre of Research Excellence.
Lead: Graeme Maguire
Since July 2010, Baker IDI Central Australia has been providing diabetes outreach services to 11 remote and very remote Central Australian communities. Baker IDI's service fills an unmet need for healthcare in Central Australian remote communities where the incidence and impacts of diabetes are severe. The project also aims to build local health services capacity to provide better practice diabetes care through in-service training and ongoing professional support.
Baker IDI's diabetes outreach services are based on a multidisciplinary model of care which pairs diabetes nurse educators with diabetes specialists, who work in concert with primary health care providers at remote health clinics. Baker IDI's diabetes nurse educators (DNE) are critical in establishing continuity with community health clinics, staff and patients; these professional relationships are a foundation for ongoing success of the service. The DNEs provide patient consultation and staff education prior to the specialist visit, support specialists during their visit, and monitor patient follow up (both in person and remotely) after the visit.
Baker IDI's outreach specialists build trusting community relationships through repeat visits to communities. Specialists run diabetes clinics twice yearly in accordance with best practice diabetes care and also provide education to health clinic staff. In this way, remote communities benefit from the most advanced care in diabetes.
Leads: Graeme Maguire and James Ward
Baker IDI Central Australia has developed the Alice Springs Hospital Readmissions Prevention Project (ASH RAPP) in collaboration with clinical leaders at the Alice Springs Hospital in response to the issue of frequent readmissions to hospital among a segment of the population. Hospital admission has a range of implications, including for the patient (e.g., isolating them from their families and communities; exposing them to hospital-associated infections) and the health care system (e.g., extending ED waiting times, overcrowding inpatient beds). Frequent readmission also indicates that health care needs are not being appropriately met in the community setting.
Anecdotal evidence from hospital-based clinicians suggests that many of these admissions may be avoidable with improved education, support, pre-discharge planning and community-based liaison and management. The ASH RAPP project aims to test the proposition that a multi-dimensional intervention based on these elements can reduce frequent readmission.
Led by an Aboriginal researcher, the Baker IDI Central Australia project is directed to adult Aboriginal Australian patients who have had five or more medical admissions over the previous 12 months. These subjects are being randomised to a control group (receiving usual care) and a study group (to receive the multi-dimensional intervention). The multi-dimensional intervention is composed of a needs based assessment, coordination with existing hospital based health care (including education, medication review, case conferencing and the development of an action plan), liaison with local primary health care providers and post-discharge follow up.
The control group and study group are being compared with respect number of readmissions, total number of patient days and ER attendance. These outcomes will suggest whether the use of multi-dimensional interventions may be an effective approach to reducing hospital readmissions of Aboriginal people in Central Australia.
Lead: Alex Brown
The Diabetes in Pregnancy (DIP) project responds to the rising rates of diabetes in pregnant women and aims to build on what is known about the impact of abnormal blood glucose levels on health outcomes for mothers and their babies. The project is investigating the extent of the issue in the NT and will provide clinical indicators to examine what is happening for the women and their infant children. Based on the findings, the DIP project will inform health care service delivery to achieve better health outcomes.
There are two parts of the project: the clinical register and the study. The DIP clinical register records routine information from women who have had diabetes in pregnancy and their babies and this information will be used to assist with planning models of health care and service delivery. The DIP research study follows women with diabetes in pregnancy and their babies over regular intervals up to 2 years. Clinical information is gathered by Baker IDI's research nurses/midwives, with the aim to inform health professionals' practice and ultimately improve the health and wellbeing of upcoming generations of Territorians.
The DIP project is being conducted in collaboration with Menzies School of Health Research and NT Department of Health, with Baker IDI Central Australia researchers carrying out the project at Alice Springs Hospital.
Lead: Graeme Maguire
There are 18 Aboriginal Housing Associations (Town Camp communities) within Alice Springs, with a total estimated population of 1,950-3,300 people. The town camps result from a legacy of exclusion of Aboriginal people from Alice Springs which resulted in many Aboriginal people living on the outskirts of town.
In close collaboration with the Tangentyere Council, Baker IDI Central Australia is undertaking the Town Camp Chronic Disease Project. The Project will examine the nature and extent of town camp residents' use of health care services for chronic disease screening, diagnosis and management, and offer on-site screening services to address potential service shortfalls.
Through a household survey, the project is determining how residents of Town Camps access health care services with a particular focus on chronic disease screening, diagnosis and management. Town camp residents are being offered chronic disease screening in conjunction with the household survey. These screening services (and delivery of health promotion messages) are being delivered through involvement of local health service providers, which provides an opportunity for clinicians to gain a greater understanding of the social, environmental and economic context of town camps. As a tangible benefit, screening may provide participating town camps residents with an up-to-date appraisal of their own health and inform them about follow up services.
The Town Camp Chronic Disease Project is expected to yield information about residents' current access to health services for screening and management of chronic diseases, while engaging key stakeholders who may be involved in developing solutions to improve access.
Lead: Alex Brown
Cardiovascular disease is the leading cause of death in the world, including among Central Australian Aboriginal people. Through the Central Australian Heart Protection Study (CAHPS), Baker IDI Central Australia is interested in the connection between health care follow up and health outcomes for people who have already suffered an acute cardiac event. The CAHPS study tests the effectiveness of a nurse-led, family based education and assessment program for reducing the incidence of poor outcomes following a hospital admission for an acute cardiac event.
The study involves recruitment of Aboriginal and non-Aboriginal participants who have been admitted to Alice Springs Hospital with a diagnosis of acute coronary syndrome in order to follow their progress for two years. Participants in the study are being randomly selected for the control group (to receive regular care) and the study group (to receive the nurse-led model of care). As part of the family-based approach, the members of the study group are able to elect a family member or buddy to join them in the study. Informed consent is essential for all study participants and Baker IDI has prepared a DVD in five Central Australian Aboriginal languages to enhance the consent process for people for whom English is not a first language.
Within 7-14 days after hospital discharge and over the next 12 months, study group participants and their 'buddies' receive a nurse-led program utilising evidence-based decision support tools, regular reviews and follow up home visits at six months and 24 months incorporating continuing clinical, social and family assessments, education, support and goal setting, integrated with the care provided by their primary care providers. Based on the social assessments, the study team may make referrals to relevant social services providers.
The CAHPS study is expected to reduce major coronary events in the study group, and to engage families in care, while improving community outreach, continuity and journeys through the healthcare system.
Lead: Graeme Maguire
There is an increasing understanding of the importance of physical activity in non-Indigenous Australians in limiting the development and progression of chronic disease. However it remains unclear whether such knowledge is directly transferrable to Aboriginal and Torres Strait Islander people. At the same time, little is known regarding the nature and level of physical activity for Aboriginal and Torres Strait Islander people both in cities and large regional centres and in remote and very remote communities. Without such knowledge it is not possible to develop or test interventions to inform future policies, public health and clinical practice.
Through an important collaboration between Baker IDI in Central Australia, Baker IDI's Physical Activity and Behavioural Epidemiology research group in Melbourne, the James Cook University and Apunipima Cape York Health Council, a three-staged program of study has been developed to improve knowledge in this area.
The study includes validating methods for collecting physical activity data and pilot data collection in an Aboriginal and/or Torres Strait Islander population in a regional setting. The study describes the level of physical activity in a regional versus remote setting, and compares data for Aboriginal Australian, Torres Strait Islander and non-Indigenous Australians.
The final stage of the project involves developing and evaluating interventions at a community and individual level to enhance physical activity and reduce chronic disease risk factors as a mechanism of primary and secondary prevention for chronic disease in Aboriginal and Torres Strait Islander people living in urban, regional and remote settings.
Lead: Jeff Reading
The health disparities suffered by Australia's Indigenous people are not unique to this country, with Aboriginal people in the United States, Canada, and New Zealand also experiencing higher rates of diabetes and other chronic diseases, greater prevalence of communicable diseases, and a shorter life expectancy compared to their non-Aboriginal counterparts.
Through the engagement of Jeff Reading in 2012, Baker IDI has joined a group of organisations in Canada, Australia, New Zealand and the United States which have a taken global view to reducing Aboriginal health disparities through research, programs and services.
International projects include Competencies for Indigenous Public Health, Evaluation and Research (CIPHER) and a proposal between Australian and Canadian investigators to study HIV care models for vulnerable populations.
Associate Professor Graeme Maguire
PhD, FRACP, MPH&TM, BMedSc, MBBS
Graeme Maguire is a specialist physician in general internal and respiratory medicine, NHMRC Practitioner Fellow and senior research fellow who holds the Margaret Ross Chair in Indigenous Health at Baker IDI Central Australia in Alice Springs. He is a Central Australian-based researcher and academic with experience in health service provision, health-related research and health policy and protocol development in regional and remote Australia and for Aboriginal and Torres Strait Islander people. As a clinician who continues to provide clinical care part time, he has a unique appreciation of the health needs of residents of rural Australia and Aboriginal and Torres Strait Islander peoples. His clinical duties also provide the opportunity to work with and support diverse health care teams. He undertook his PhD studies in remote northern Australian communities extending across the north of the Northern Territory. Along with his experience working as a hospital- and community-based outreach physician in remote Australia, he has a well-developed an appreciation of the realities of health care in regional and remote Australia.
Read more about Graeme Maguire here.
Airflow obstruction, respiratory symptoms and respiratory illnesses in Australians aged 40 years and older: the Burden of Obstructive Lung Disease (BOLD) study in Australia. Med J Aust 2013;198(3):144-8.
Improving management for people living with chronic lung disease in rural and remote Australia: the Breathe Easy Walk Easy program. Respirology 2013;18(1):161-9.
Bronchiectasis: a guide for primary care. Aust Fam Physician 2012;41(11):842-50.
World Heart Federation criteria for echocardiographic diagnosis of rheumatic heart disease-an evidence-based guideline. Nat Rev Cardiol 2012;9(5):297-309.
Infective endocarditis and rheumatic heart disease in the north of Australia. Heart Lung Circ 2012;21(1):36-41.
Chronic suppurative lung disease and bronchiectasis in children and adults In Australia and New Zealand. Med J Aust 2010;193(6):356-65.
A simple, valid, numerical score for grading chest X-ray severity in adult smear positive pulmonary tuberculosis. Thorax 2010;65:863-9.
Community-acquired pneumonia in the central desert and north-western tropics of Australia. IMJ 2010;40(1):37-44.
Pulmonary tuberculosis, impaired lung function, disability and quality of life in a high burden setting. Int J Tuberc Lung Dis 2009;13(12):1500-6.
Improving inpatient management of community-acquired pneumonia in remote northern Australia. Aust J Rural Health 2008;16:383-4.
Point-of-care testing of capillary glucose in the exclusion and diagnosis of diabetes in remote Australia. Med J Aust 2007;186:500-3.
Lung injury in vivax malaria: Pathophysiological Evidence for Pulmonary Vascular Sequestration and Posttreatment Alveolar-Capillary Inflammation. J Infect Dis 2007;195:589-96.
Normal spirometry, gas transfer and lung volume values in Papua, Indonesia. Southeast Asian Journal of Public Health and Tropical Medicine 2006;37(3).
Health and health preparation of older travellers in remote Australia. Aust Fam Physician 2006; 35(1/2):70-2.
Lung injury in uncomplicated and severe falciparum malaria: a longitudinal study in Papua, Indonesia. J Infect Dis 2005;192:1966-74.
Point-of-care testing of HbA1c and blood glucose in a remote Aboriginal Australian community. Med J Aust 2005;182:524-7.
Bring me home: renal dialysis in the Kimberley. Nephrology 2004;9:S121-5.
Pulmonary manifestations of uncomplicated falciparum and vivax malaria: cough, small airways obstruction, impaired gas transfer, and increased pulmonary phagocytic activity. J Infect Dis 2002;185:1326-34.
Clinical experience and outcomes of community-acquired and nosocomial MRSA in a northern Australian hospital. J Hosp Infect 1998;38:273-81.
Associate Professor Graeme Maguire - Executive Director
James Ward - Deputy Director
Professor Jeff Reading - Associate Director, Global Indigenous Health
Scott Bendall - Research Nurse
Professor Alex Brown - Senior Research Fellow
Barbara Molanus - Research Coordinator
Bernadette Rickards - Research Nurse
Glynis Cacavas - CAHPS Coordinator
Helen Liddle - Indigenous Research Fellow
Joanna Kelaart - Research Nurse
Jodi Lennox - Research Coordinator
Julie Fielke - Research Nurse
Paula Van Dokkum - Research Nurse
Ricky Mentha - Indigenous Research Fellow
Samantha Togni - Research Coordinator
Stacey Svenson - Research Nurse
Steve Warren - Research Nurse
Sharon Johnson - Diabetes Nurse Educator
Associate Professor Neale Cohen - Epidemiologist; diabetes outreach service provider
Associate Professor Jonathan Shaw - Epidemiologist; diabetes outreach service provider
Coleen Doherty - Administration Support Officer
Catherine Geraghty - Executive Administrator
Geeta Cheema - General Manager