Checks and cheques : implementing a population health and recall system to improve coverage of patients with diabetes in a rural general practice

Identification of all diabetic patients in the population is essential if diabetic care is to be effective in achieving the targets of the St Vincent Declaration.1 The challenge therefore is to establish population based monitoring and control systems by means of state of the art technology in order to achieve quality assurance in the provision of care for patients with diabetes. 2,3 Disease management receives extensive international support as the most appropriate approach to organising and delivering healthcare for chronic conditions like diabetes.4 This approach is achieved through a combination of guidelines for practice, patient education, consultations and follow up using a planned team approach and a strong focus on continuous quality improvement using information technology. 5,6 The current software (Medical Director) could not easily meet these requirements which led us to adopt a trial of Ferret. In designing this project we used change management7 and the plan, do, study, act cycle8 illustrated in Diagram 1.<br /

Using care plans to better manage multimorbidity

BACKGROUND: The health care for patients having two or more long-term medical conditions is fragmented between specialists, allied health professionals, and general practitioners (GPs), each keeping separate medical records. There are separate guidelines for each disease, making it difficult for the GP to coordinate care. The TrueBlue model of collaborative care to address key problems in managing patients with multimorbidity in general practice previously reported outcomes on the management of multimorbidities. We report on the care plan for patients with depression, diabetes, and/or coronary heart disease that was embedded in the TrueBlue study. METHODS: A care plan was designed around diabetes, coronary heart disease, and depression management guidelines to prompt implementation of best practices and to provide a single document for information from multiple sources. It was used in the TrueBlue trial undertaken by 400 patients (206 intervention and 194 control) from 11 Australian general practices in regional and metropolitan areas. RESULTS: Practice nurses and GPs successfully used the care plan to achieve the guideline-recommended checks for almost all patients, and successfully monitored depression scores and risk factors, kept pathology results up to date, and identified patient priorities and goals. Clinical outcomes improved compared with usual care. CONCLUSION: The care plan was used successfully to manage and prioritise multimorbidity. Downstream implications include improving efficiency in patient management, and better health outcomes for patients with complex multimorbidities

Preventing diabetes through a lifestyle modification program that works

The Greater Green Triangle Diabetes Prevention Project was a national demonstrator program that was conducted in Hamilton, Horsham and Mount Gambier by the GGT UDRH in 2004 to 2006. The project was based on the Finnish Diabetes Prevention Study and the Good Ageing in Lahti Region Lifestyle Implementation Trial. It involved a series of group education sessions delivered to people at high risk of developing diabetes. As the positive effect of diabetes prevention programs is already well established, the aim of this study was to evaluate the feasibility of delivering a structured group-based lifestyle modification program in Australian primary care settings with modest resources. A follow-up investigation looked at whether gains achieved by the intervention were sustained longer term and whether telephone support would provide better outcomes

The potential for measuring ethnicity and health in a multicultural milieu - the case of type 2 diabetes in Australia

ObjectiveEthnicity influences health in many ways. For example, type 2&nbsp;diabetes (T2DM) is disproportionately prevalent among certain ethnic groups.&nbsp;Assessing ethnicity is difficult, and numerous proxy measures are used to&nbsp;capture its various components. Australian guidelines specify a set of&nbsp;variables for measuring ethnicity, and how such parameters should be&nbsp;categorised. Using T2DM data collections as an illustrative example, this&nbsp;study sought to examine how ethnicity is measured in Australian health&nbsp;databases and, by comparing current practice with Australia&rsquo;s existing&nbsp;benchmark recommendations, to identify potential areas for improvement of&nbsp;the health data landscape.DesignWe identified databases containing information from which ethnic&nbsp;group-specific estimates of T2DM burden may be gleaned. For each&nbsp;database, details regarding ethnicity variables were extracted, and compared&nbsp;with the Australian guidelines.&nbsp;ResultsData collection instruments for 32 relevant databases were reviewed.&nbsp;Birthplace was recorded in 27 databases (84%), but mode of birthplace&nbsp;assessment varied. Indigenous status was commonly recorded (78%, n=25), but&nbsp;only nine databases recorded other aspects of self-perceived race/ethnicity. Of&nbsp;28 survey/audit databases, 14 accommodated linguistic preferences other than&nbsp;English, and 11 either excluded non-English speakers or those for whom a&nbsp;translator was not available, or only offered questionnaires in English.ConclusionsConsiderable variation exists in the measurement of ethnicity in&nbsp;Australian health data- sets. While various markers of ethnicity provide&nbsp;complementary information about the ethnic profile within a data-set, nonuniform&nbsp;measurement renders comparison between data-sets difficult. A&nbsp;standardised approach is necessary, and identifying the ethnicity variables&nbsp;that are particularly relevant to the health sector is warranted. Including self identified&nbsp;ethnicity in Australia&rsquo;s set of recommended indicators and as a core&nbsp;component of the national census should be considered. Globalisation and&nbsp;increasing migration mean that these findings have implications internationally,&nbsp;including for multi-ethnic countries throughout North America and&nbsp;Europe.</div

Addressing evidence treatment gaps for cardiovascular disease through primary care collaboration

Aims &amp; Rationale/ObjectivesThe aim is to establish the frequency of counselling by general practitioners (GPs) and community pharmacists (CPs) for patients with uncontrolled CVD risk factors. This will identify conditions for which CPs might collaborate with GPs in addressing evidence-treatment gaps.MethodsA population survey undertaken in the Wimmera region of Victoria in 2006. 1425 adults aged 25-84 yrs were randomly selected using age/sex stratified electoral role samples. A representative 723 participants were recruited.Principal FindingsData on GP and CP visits were available for 694 participants. Overall, participants visited GPs 4.6 times and CPs 6.0 times/annum. However, one third of participants never consulted a pharmacist in 12 months compared to just 11.5% for GPs. Among obese patients (BMI ?? 30), the average number of visits/annum was 4.5 to GPs and 6.8 to CPs. The equivalent numbers were 5.6 and 8.6 respectively for those with systolic BP ?? 140 mmHg; 3.7 and 5.5 for total cholesterol &gt; 5.0 mmol/L; and, 6.7 and 14.6 for patients with random blood glucose concentrations ?? 7.0 mmol/L.ImplicationsPeople with suboptimal status for most common CVD risk factor are counselled frequently by CPs. A coordinated approach with GPs to the delivery of cardiovascular health promotion could provide valuable reinforcement of key messages and offers greater opportunity to identify at-risk individuals. Acknowledgements: KM is a pharmacist-academic at Greater Green Triangle UDRH, a position funded by the Department of Health and Ageing through the Rural and Remote Pharmacy Workforce Development Program<br /

In the wake of hospital inquiries : impact on staff and safety

Mishandled concerns about clinical standards resulted in whistleblowing in four Australian hospitals. Official inquiries followed with recommendations to improve patient safety. In the aftermath of the inquiries, common themes included loss of trust in management and among clinical colleagues, and loss of trust from patients and the community. Without first rebuilding trust, staff will not report mistakes or other concerns about safety. Successful implementation of patient safety procedures requires policies to stress the professional duty of staff to report concerns about colleagues when they believe there is a risk to patients.<br /