1 Diabetes-Where to from here ? Prepared by [Lynne Gilks] [CNC Diabetes Education] [Diabetes Centre, Tamworth] [November 2009]

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Diabetes-Where to from here?Prepared by [Lynne Gilks][CNC Diabetes Education]

[Diabetes Centre, Tamworth]

[November 2009]

Diabetes-Where to from here?

Diabetes is a relatively common condition affecting about 7.8% Australian population (AusDiab study)

In some Aboriginal communities prevalence rates can be as high as 31%. (DA NSW)

Impaired Glucose Tolerance or Impaired Fasting Glycaemia affects 16.3% of the population (AusDiab)

1 in 4 Australians 25 yrs & over has Diabetes or IGT/IFG (AusDiab)

Diabetes has increased by 300% over the last 10 years. (DA NSW)


Currently in Australia 275 people are being diagnosed with diabetes each day i.e. 100,000 new cases per year

The rate of Diabetes in the lowest socioeconomic group is almost twice that compared with the highest socioeconomic group


The number of people with Diabetes is expected to double by 2010

Type 2 Diabetes is predicted to have the largest increase of the chronic diseases by 2020

Associated costs are predicted to increase by 679% by 2031.

Diabetes-where to from here?

Cost of diabetes in Australia in 2005 was $10.3 billion of which:

* Health system costs $1.1 billion

*Productivity lost $4.1 billion

*Carer costs $4.4 billion

As well

*Lost wellbeing $11.6 billion

Total cost of diabetes in 2005 $21.3 billion

(NSW Diabetes Action Plan)


Despite this epidemic of diabetes there has been little corresponding increase in staffing.

In 2008 in NSW there are

* 920 Dietitians

* 800 Podiatrists

* 250 Diabetes Educators

* 130 Endocrinologists


In NSW according to Diabetes Australia NSW figures there are more than 271,000 people diagnosed with DM therefore

For every 1 Dietitian there are 295 PWD

For every 1 Podiatrist there are 339 PWD

For every Diabetes Educator there are 1,084 PWD

For every Endocrinologist there are 2,085 PWD



Implications

Increase in waiting times to see specialist services

Lack of resources to run preventative programs

Prioritorising which clients to see first

Less time for individual consultations

Discharging clients from specialist Diabetes services to GP’s when well managed

Possible burnout of overworked staff


How do we use existing resources to maximise accessibility?

Training of existing Health Professionals (such as Practice Nurses & GP’s ) to handle people with non complicated type 2 diabetes.

Referral to specialist services for more complicated patients

Collaborative programs with GP’s & Allied Health

More group programs

Encourage patients to more self management.


Courses for Practice Nurses

National Association of Diabetes Centres’ Training program

Australian Diabetes Educators’ Association online training program

Diabetes Australia, NSW & virtualMedicalCentre.com- www.virtualnursingeducation.com

Australian Practice Nurse Association online module

http://www.virtualnursingeducation.com/


Practice Nurses are not Diabetes Educators however-

They can provide basic education, support & encouragement at diagnosis

Explain benefits of exercise and advise of available local programs

Give basic advice on healthy eating

Explain benefits of weight loss & control

Advise on locally available healthy lifestyle programs

Identify those patients who require referral to group education &/or more specialist service

Review with patients their annual cycle of care & clinical targets


Development of greater links between GP’s, Diabetes Educators (DE) & Allied Health.

From May 1st 2007 Medicare allowed GP’s to refer patients to group sessions conducted by Credentialed Diabetes Educator, an Accredited Practicing Dietitian or an Accredited Exercise Physiologist (who are registered providers with Medicare) using normal GP plan rather than a team care plan.


Thus people with Type 2 DM referred by their GP are entitled to an initial individual assessment, followed by up to eight group sessions in a calendar year provided by eligible Health Professionals.


Chronic Disease management (CDM) Medicare Items (Enhanced Primary Care):

Preparation of a GP management Plan (Item 721)

Review of a GP Management Plan (Item 725)

Coordination of Team Care arrangement (TCA-Item 723)

Coordination of Review of TCA (Item 727)

Practice Nurse support & management


Team Care arrangement which involves GP & at least 2 other care providers.

5 individual Allied Health Visits available to eligible patients per calendar year with Team care arrangement.


Eligible Allied Health Professionals:

Aboriginal Health Worker

Audiologist

Chiropractor

Diabetes Educator

Dietitian

Exercise Physiologist


Mental Health worker

Occupational therapist

Osteopath

Physiotherapist

Podiatrist

Psychologist

Speech Pathologist


Also incentive payments to GP’s to complete annual cycle of care including BP, BMI, HbA1C, lipids, smoking, nutrition, alcohol, & physical activity as well as complications screening-eyes, feet & kidneys.


Some local GP’s run diabetes clinics within their practice for non complicated Diabetes

360 Health clinic group program

TCA in conjunction with Diabetes services

Medical student from UNE attending Diabetes Centre as part of their training

Practice Nurses attending NADC course

Tamworth Diabetes Centre provides advice & support to GP’s & Practice Nurses

Discharge guideline


Discharge Guideline:

Objectives

Service Description

Service Priorities

Intake System

Discharge procedure for Type 2 DM

Discharge criteria for Type 2 DM

Discharge criteria for women with Gestational Diabetes


Objectives

Intake of clients for DNE & Dietitian

Priority clients

Timely & appropriate discharge


Priority Clients

Children

Pregnant women with DM

Type 1 DM

People with DM related complications

Type 2 commencing insulin

Aboriginal & TSI

Unstable DM


Discharge

Well controlled or when education is complete Type 2 DM to be discharged back to LMO with letter

Chime closed


Discharge Criteria for Type 2 DM:

Well controlled DM with HbA1C <7% and/or BG 4 to 8 mmol/l

If there has been an improvement in glycaemic control & client shows evidence of maximum capacity for improvement has been reached


Type 2 Insulin commencement

Client taught how to adjust insulin

Client aware of target for blood glucose

Review appointment to monitor progress

When stable refer back to LMO


Documents

1 Diabetes-Where to from here ? Prepared by [Lynne Gilks] [CNC Diabetes Education] [Diabetes Centre, Tamworth] [November 2009]