Centre of Research Excellence for Prevention of Chronic Conditions in Rural & Remote Communities



Chief Investigator: Professor Robyn McDermott, email: robyn.mcdermott@unisa.edu.au

CRE Manager / co-ordinator: Madeleine Mallee- UniSA, email: madeleine.mallee@unisa.edu.au

Policy context

Very high rates of diabetes, heart and renal disease and preventable complications from these, continue among people in rural and remote areas, particularly Indigenous Australians. There is now good evidence for the effectiveness of primary care-based interventions to prevent progression of established disease, and also prevent new disease in people at high risk. There are many different approaches to PHC service delivery in remote communities, often with a combination of resident and outreach clinical and health promotion staff. What is not known is how well these various models of care translate into improved health outcomes in clients, particularly in keeping people out of hospital by preventing disease progression.

Important questions include: What are the main characteristics of chronic care employed by the services and how is implementation fidelity monitored? What is behind the variation in quality of care as measured by audits, and does this affect health outcomes? What is the contribution of good information and reporting systems to quality of chronic care? How do different kinds of staffing models contribute to outcomes?


This Centre brings together researchers and clinicians who collectively have experience in remote health care, clinical epidemiology, chronic disease prevention and management, health promotion, economics, policy development, program implementation and evaluation, and who have extensive clinical and research networks. The Centre is supported by international and national experts in primary care and chronic disease prevention and will generate new knowledge directly relevant to policy, as well as encouraging young and novice researchers into this important multidisciplinary field.

The Centre will employ a ‘mixed methods’ approach. In particular the Centre will:

  • Establish whole-of-service cohort studies by enrolling at least 80% of adult clients with identified chronic conditions and risk factors (with informed consent) and tracking them through the health care system prospectively. Researchers aim to link PHC, selected pathology, hospitalisations, MBS, PBS and death registers. Over time, researchers will be able to measure how different service models contribute to critical care processes (checks, active management including smoking cessation, quality use of medicines) and outcomes (progression of disease especially renal function; preventable hospitalisations and deaths).
  • Utilise a continuous quality improvement approach in a participatory action framework to clarify aspects of PHC service models which appear to be important from the evidence and from interviews with clients and staff and assess whether various aspects of the models of care are implemented as planned and how these line up with effective community prevention activities.
  • Look at value for money: how do budgetary and staffing inputs relate to health outcomes.
  • Look at how well the workforce mix lines up with the needs of the community.

Researchers will work closely with eight regional communities in SA and Queensland to answer these questions. Findings will be used to inform current and new policy for nutrition, health promotion and clinical services.


  1. Robertson J, Stevenson L, Usher K, Devine S, Clough A. A Review of Trends in Indigenous Australian Tobacco Research (From 2004 to 2013), its Associated Outputs and Evidence of Research Translation. Nicotine Tob Res. 17(8):1039-48.doi:10.1093/ntr/ntv018, 2015.
  1. van Gaans D, D’Onise K, Cardone T, McDermott R. The Development of the Public Health Research Data Management System. electronic Journal of Health Informatics. 9(1):e10, 2015.
  1. Clough AR, Fitts M, Robertson J. Recent warnings of a rise in crystal methamphetamine ("ice") use in rural and remote Indigenous Australian communities should be heeded. Med J Aust. 203(1):19, 2015.
  1. Hays R, Esterman A, Giacomin P, Loukas A, McDermott R. Does Strongyloides stercoralis infection protect against type 2 diabetes in humans? Evidence from Australian Aboriginal adults. Diabetes Res Clin Pract. 107(3):355-61, 2015.
  1. Li M, McDermott R. Smoking, poor nutrition, and sexually transmitted infections associated with pelvic inflammatory disease in remote North Queensland Indigenous communities, 1998-2005. BMC Womens Health. 15:31.doi: 10.1186/s12905-015-0188-z, 2015.
  1. McDermott RA, Schmidt B, Preece C, Owens V, Taylor S, Li M, Esterman A. Community health workers improve diabetes care in remote Australian Indigenous communities: results of a pragmatic cluster randomized controlled trial. BMC Health Serv Res. 15:68. doi:10.1186/s12913-015-0695-5, 2015.
  1. Johnson DR, McDermott RA, Clifton P, D'Onise K, Taylor SM, Preece CL and Schmidt BA. Characteristics of Indigenous adults with poorly controlled diabetes in north Queensland: implications for services. BMC Public Health. 15:325. doi: 10.1186/s12889-015-1660-2, 2015.
  1. Hays R, Esterman A, and McDermott R. Type 2 diabetes mellitus is associated with Strongyloides stercoralis treatment failure in Australian aboriginals. PLoS Neglected Tropical Disease, 9 (8). pp. 1-10, 2015.
  1. Hays R, and McDermott R. Strongyloides stercoralis infection and antenatal care. Medical Journal of Australia, 203 (1). i-ii, 2015.
  1. Harriss L, Dey A, Thompson F, and McDermott R. Cairns Hospital Emergency Department presentations: 12-Month report 2013-2014. Report. Centre for Chronic Disease Prevention, James Cook University, Cairns, QLD, Australia, 2015.
  1. Usher K, Clough A, Woods C, and Robertson J. Is there an ice epidemic in Australia. International Journal of Mental Health Nursing, 24 (4). pp. 283-285, 2015.
  1. Stevens B, Buttner P, Watt K, Clough A, Brimblecombe J, and Judd J. The effect of balanced protein energy supplementation in undernourished pregnant women and child physical growth in low- and middle-income countries: a systematic review and meta-analysis. Maternal and Child Nutrition. 11(4):415-32, 2015. 
  1. Miller A., Massey P.D., Judd J., Kelly J., Durrheim D.N., Clough A.R., Speare R., and Saggers S. Using a participatory action research framework to listen to Aboriginal and Torres Strait Islander people in Australia about pandemic influenza. Rural and Remote Health, 15. pp. 1-10, 2015.
  1. Clough AR., and Bird K. The implementation and development of complex alcohol control policies in indigenous communities in Queensland (Australia). International Journal of Drug Policy, 26 (4). pp. 345-351, 2015.
  1. Gould GS, Watt K, McEwen A, Cadet-James Y, and Clough, AR. Predictors of intentions to quit smoking in Aboriginal tobacco smokers of reproductive age in regional New South Wales (NSW), Australia: quantitative and qualitative findings of a cross-sectional survey. BMJ Open, 5. pp. 1-10, 2015.
  1. Gould GS, Watt K, Cadet-James Y, and Clough, AR. Using the risk behaviour diagnosis scale to understand Australian Aboriginal smoking — a cross-sectional validation survey in regional New South Wales. Preventive Medicine Reports, 2. pp. 4-9, 2015.
  1. Li M, and McDermott RObesity, Albuminuria, and Gamma-Glutamyl Transferase Predict Incidence of Hypertension in Indigenous Australians in Rural and Remote Communities in Northern Australia. Journal of Hypertension 33.4: 704–710, 2015.
  1. Schmidt B, Campbell S, McDermott R. Community Health Workers as chronic care coordinators: A process evaluation of an Australian Indigenous primary health care program in six communities in far north Queensland. ANZ Journal of Public Health. DOI: 10.1111/1753-6405.12480, 2015.
  1. Fitts M, West C,  Robertson J, Robertson K, Roberts N, Honorato B, Clough A. The NHMRC Road Map 'benchmark' principles: A formal evaluation process is needed to improve their application. Australian & New Zealand Journal of Public Health, 39:4. 305-308, 2015.
  1. van Gaans D, Hugo G, Tonkin A. The development of a spatial model of accessibility to phase 2 cardiac rehabilitation programs. Journal of Spatial Science. DOI:10.1080/14498596.2015.1059375, 2015.
  1. Clough A, Robertson J, Fitts M, Lawson K, Bird K, Hunter E et al. Impacts of meth/amphetamine, other drugs and alcohol in rural and remote areas in Northern and north-east Queensland: as environmental scan. James Cook University. ISBN 978-0-9942333-6-3, 2015.
  1. Woods, C., Usher, K., Edwards, A., Jersmann, H. & Maguire, G.. The tyranny of distance-mapping accessibility to polysomnography services across Australia. Australian Indigenous Health Bulletin, 15(3), 2015.
  1. Thomas DP, Panaretto KS, Stevens M, Borland R. Dependence in a national sample of aboriginal and torres strait islander daily smokers. Med J Aust., 202(10):S39-44, 2015.
  1. Thomas DP, Briggs VL, Couzos S, Panaretto KS, van der Sterren AE, Stevens M, Borland R. Use of nicotine replacement therapy and stop-smoking medicines in a national sample of aboriginal and torres strait islander smokers and ex-smokers. Med J Aust., 202(10):S78-84, 2015.
  1. Thomas DP, Bennet PT, Briggs VL, Couzos S, Hunt JM, Panaretto KS, Stevens M, Borland R. Smoking cessation advice and non-pharmacological support in a national sample of aboriginal and torres strait islander smokers and ex-smokers. Med J Aust., 202(10):S73-7, 2015.
  1. Thomas DP, Briggs VL, Couzos S, Davey ME, Hunt JM, Panaretto KS, van der Sterren AE, Stevens M, Nicholson AK, Borland R. Research methods of talking about the smokes: an international tobacco control policy evaluation project study with aboriginal and torres strait islander australians. Med J Aust., 202(10):S5-12, 2015.
  1. Thomas DP, Davey ME, Panaretto KS, Hunt JM, Stevens M, van der Sterren AE. Smoking among a national sample of Aboriginal and Torres Strait Islander health service staff. Med J Aust., 202(10):S85-9, 2015.
  1. Thomas DP, Panaretto KS, Stevens M, Bennet PT, Borland R. Smoke-free homes and workplaces of a national sample of aboriginal and torres strait islander people. Med J Aust., 202(10):S33-8, 2015.
  1. D’Onise K, McDermott RA, Lynch JW. ‘Center based preschool programs: systematic review of child and adult health outcomes’ in Reynolds AJ, Rolnick AJ, Temple JA, Health and Health Education in Early Childhood: Predictors, Intervention and Policies. Cambridge University Press, Cambridge UK, 2014, pp. 145-200. Book Chapter 7
  1. Li M, McDermott R. Albuminuria and its associated biomedical factors among indigenous adults in Far North Queensland: a 7-year follow up study. BMC nephrology, 16 (1): 208, 2015.
  1. Roe YL, Esterman A, McDermott R, Zeitz C. The management of Indigenous patients presenting with non ST‐segment elevation acute coronary syndrome in South Australia: a retrospective cohort study. Internal medicine journal, DOI: 10.1111/imj.12949, 2015. 
  1. Krieg A, Guthrie J, Levy M, Segal L. What’s health got to do with it? - Reforming justice for Indigenous Australian communities.  MJA, in press, accepted December 2015




Updated:  24 April 2017/Responsible Officer:  Director, APHCRI/Page Contact:  Web Admin, APHCRI