Detecting DiabetesTools for better care

Diabetes in New Zealand

• 170 000 people with diabetes• 155 000 – type 2, 15 000 type 1• Ethnic differences

– European 4.3 %– Maori 5.8 %– Asian 6.5 %– Pacific 10.0 %

Identifying people with diabetes, IGT or IFG provides the opportunity for intervention, which in turn, may delay the onset of complications.

To identify those at risk, a targeted screening programme of at risk people remains the most practical and cost effective approach.

Overcoming barriers

• Over the last 10 years diabetes testing in New Zealand has shown marked improvement

• It is worth putting extra effort into those who remain undiagnosed

Barriers

• Some barriers are common to many practices

• But many others will be unique due to each practice

• Methods for overcoming barriers can not be prescriptive – solutions need to be as individual as the issues each practice faces

Identifying the barriers…

• Is diabetes testing available?

Does the practice have the knowledge and tools to provide testing?

Identifying the barriers…

• Is diabetes testing appropriate?

Are the right people getting the right tests at the right time?

Identifying the barriers…

• Is diabetes testing accessible?

Are the people that need testing able to access the service?

Identifying the barriers…

• Is diabetes testing acceptable?

Is testing culturally acceptable to your practice population?

Is diabetes testing available?

• Focus: does the practice have the knowledge and tools to provide testing?

Question:Has your practice considered the best way to identify people with undiagnosed diabetes?

Barriers to the availability of care

• No plan for identifying patients with undiagnosed diabetes

• Lack of recognition of the importance of early detection of hyperglycaemia

• Practical constraints on the practice eg time, resources

Is diabetes testing appropriate?

• Focus: Are the right people getting the right tests at the right time?

QuestionsDoes the practice have a method for identifying people at high risk of diabetes?Is the practice aware of which tests are considered the best for the diagnosis of diabetes?

Barriers to appropriate testing

• People with symptoms of diabetes are not being identified

• People at high risk of diabetes are not being tested

• People are not being testing as part of CVD assessment

Is diabetes testing accessible?

Focus: the people that need testing able to access the service?

QuestionsHave you considered measures to overcome access barriers?Do you promote the health benefits of early diagnosis of diabetes? Do you follow up people who fail to attend?

Barriers to access for diabetes care

• Cost or perceptions of value• Location of practice• Getting time off work, child and elder

care• Having to arrange an appointment

and time spent getting tests• Achieving fasting status• Fear testing or having diabetes• Prior negative experiences• Patient apathy

Is diabetes testing acceptable?

• Is testing culturally acceptable to your practice population?

QuestionsHas the practice considered how it can best manage the needs of the various cultural groups represented in the practice?Have you established relationship with Maori and Pacific providers who may be able to assist?Does your PHO have specific programmes and resources you can utilise?

Barriers to providing acceptable diabetes care

• Some aspects of the practice may be unacceptable to some groups of people

• Lack of cultural competence• Lack of involvement from

patients• Methods of communication may

be off putting to some people

Tool A: Practice Action plan

• Use in a practice meeting discussion

• Discuss barriers to an effective system

• Identifying ways for overcoming barriers

Tool B: Testing guide

• Knowledge guide focusing on appropriate testing

Tool C: Poster

• Place poster in area visible to patients to help raise awareness

Tool D: PMS Alert

• Use your PMS system to help identify eligible people

Tool E: Recall letter

• Set up a patient recall system

Tool F: Patient handout

• “Why tests me for diabetes” patient leaflet

Tool G: Peer group review

• Focuses on the system you currently

• Examining barriers • Suggesting tools to help• Consider as a starting point. • Try and come up with innovative

new ideas!