Diabetes Strategy NewsletterFrom: Dr. Joshua Tepper,Executive SponsorA newsletter for diabetesstakeholders

Issue #5 - September 2010

Regional Coordination CentresOne of the biggest problems facing health planners in large jurisdictions is ensuring that levels of care are consistent regardless of where the people receiving that care are located. Ontario is, to say the very least, a large jurisdiction, and the Ontario Diabetes Strategy is focused on having the quality of care, amount of education and level of support for those with the disease be the same from one end of the province to the other.

To address this, the Ministry of Health and Long-Term Care launched 14 Diabetes Regional Coordination Centre (RCC) sites, one in each of the Local Health Integration Networks across Ontario. RCCs do not provide direct patient services, but instead work with their LHIN and service providers to coordinate and align diabetes care, and promote the best possible health outcomes for people with the disease. The RCCs are currently establishing their teams, and when they are fully staffed, a typical model will feature a regional administrator/director, a primary care lead, an analyst, a consulting endocrinologist, an outreach coordinator and an administrative assistant.

Catherine Statton is Regional Administrator of the Regional Coordination Centre in the South West LHIN. She says the fact that the RCC does not provide direct services allows the RCC team to step back and focus on the bigger picture.

“What’s lovely about the RCCs is their focus on quality improvement,” says Statton. “We have the opportunity to ask what’s happening out there, and if we see discrepancies, to ask why. And what we can, and should, do about it.”

Statton points to different approaches to diabetes education as an area that RCCs will examine in their first year. Some communities offer people with diabetes access to innovative group classes, as well as one-on-one sessions when required. In other areas, people have only occasional visits to their family doctor.

“Clearly, we need to do better than that. If there are areas doing things particularly well, we need to take those best practices and see that they are put into place everywhere else. That’s what RCCs have been created to do, and that’s what we’re going to do.”

Diabetes Regional Coordination Centres LHIN Site

1. Erie St. Clair Windsor Regional Hospital

2. South West South West CCAC

3. Waterloo Wellington Lang’s Farm Village Association (CHC)

4. Hamilton Niagara Hamilton Health Sciences Haldimand Brant

5. Central West William Osler Health Centre

6. Mississauga Halton Halton Healthcare Services

7. Toronto Central South Riverdale Community Health Centre

8. Central Southlake Regional Health Centre

9. Central East Charles H. Best Diabetes Centre

10. South East Merrickville District Community Health and Services Centre

11. Champlain Centretown Community Health Centre

12. North Simcoe Orillia Soldiers’ Memorial Hospital Muskoka

13. North East Northern Diabetes Health Network(NDHN)

14. North West Northern Diabetes Health Network(NDHN)

Community TourOne of the key tools being employed by the Ontario Diabetes Strategy this summer is a travelling education program designed to empower Ontarians and showcase the fact that it is possible to effectively manage the disease. Ontarians are being taught to Stand up to Diabetes in communities right across the province. The tour kicked off on August 4 in Brantford, and will continue in nine other locations throughout the month of August.

“When we talk about standing up to diabetes, we’re talking about taking control back from the disease,” says Sheila Banks-Switzer of the Ontario Diabetes Strategy. “People need to know that they can do this. They need to know that with proper self-management they can live full, happy and productive lives. That’s an important message, and this tour is taking it right around the province.”

In each of its locations, the Stand up to Diabetes Community Tour sets up as an easily accessible display in prominent public spaces, such as malls or shopping centres. People with diabetes, the media, or interested members of the public are encouraged to come in and speak to either a Diabetes Nurse Educator or a representative of the Canadian Diabetes Association (CDA). Also on hand is an EatRight Ontario dietician to talk about the importance of healthy eating and the best food to help manage diabetes, with local chefs demonstrating CDA-approved recipes and diabetes-friendly menu examples. In addition, a fitness expert demonstrates exercises that people can easily do at home.

Wendy Bileski-Weir is a Diabetes Nurse Educator taking part in the initiative. She says the most important thing she and her colleagues can do is give people the tools they need to better manage their diabetes with support.

“Diabetes can be an overwhelming chronic disease for those both newly diagnosed and those already living with diabetes. What we want people to know first is that in most cases it is manageable. Secondly, we want them to know the various ways that individuals can manage their diabetes by learning basic self- management skills such as diet, exercise and blood glucose testing. Thirdly, we are sharing knowledge about three important tests for managing this disease and maintaining health; the blood test to measure sugar control; the blood test for cholesterol and retinal eye exams. Regular foot exams and kidney function tests are also key to good health.

When you stand up to diabetes, you don’t have to stand alone. There are many supports within your community. Speak to your health care provider about available resources. That’s what we’re focusing on in this tour.”

Visitors to the Stand up to Diabetes display will be given information pamphlets and brochures, as well as a diabetes tool kit and information about existing Diabetes Education Programs in or near their communities.

For more information about the Ontario Diabetes Strategy or the Stand up to Diabetes Community Tour, contact diabetes@ontario.ca

Baseline Diabetes Dataset Initiative On April 26, 2010, a letter was sent to more than 10,000 primary care physicians in Ontario on behalf of both the Ministry of Health and Long-Term Care and the Ontario Medical Association. The letter informed physicians of the province’s latest tool in helping Ontarians Stand up to Diabetes: the Baseline Diabetes Dataset Initiative (BDDI).

BDDI was designed to inform physicians of three key test dates for their patients with diabetes. There are three key tests that people living with diabetes should receive on a regular basis. They are:

• the HbA1C blood glucose test, which is recommended at least every six months;

• the LDL-C cholesterol test, which patients should receive at least every year; and

• a retinal eye exam, which patients should receive at least every two years.

As of March 31, 2010, it was estimated that approximately 38 percent of Ontarians living with diabetes have all three of these tests within the recommended time periods. The government is determined to change that, and has set a target of 80 percent of Ontarians with diabetes, aged 18 and older, receiving their tests according to the optimal recom-mended guidelines. Seema Sethi, Project Implementation Manager of the Ontario Diabetes Strategy, says that’s where BDDI comes in.

“Physicians who have participated in this initiative have received invaluable information regarding their patients’ testing dates. They will know if a patient is overdue for a test and can remind them, explain the importance of these tests and continue to help their patients with better diabetes care.”

Of the physicians who received the letter back in April, over 5,400 have elected to participate by returning validated patient lists of their patients with diabetes, meaning that more than 545,000 Ontarians with diabetes have been included in this initiative. At the end of June, participating physicians received Detailed Diabetes Testing Reports, which included the dates on which their patients last received the three

key tests, as well as aggregate information about how their practice results compare to others within the Local Health Integration Network, and the rest of the province.

Dr Michael Toth is Co-Chair of the Diabetes Advisory Group for the OMA. He says that BDDI is already helping physicians and patients better manage diabetes, and he hopes more physicians will participate in the initiative as it moves forward.

‘‘In a few months, physicians who have not participated will be given the chance to do so. They will join the more than 5,000 doctors that now know exactly who among their patients with diabetes is getting tested regularly, and who needs help and reminding. That means better care and better outcomes for patients.”

Physicians who have not participated in this initiative can do so in November during Diabetes Month. The ministry will be sending out Patient Validation Lists to physicians who have not participated yetand updated Detailed Diabetes Testing Reports to physicians whohave participated.

Patients who do not want their names and information to be made available in BDDI should call the ministry at 1-800-291-1405, TTY: 1-800-387-5559 to withdraw from this initiative and inform their physicians of their withdrawal. Anyone looking for more information about the Ontario Diabetes Strategy, or BDDI in particular, should contact the Strategy at diabetes@ontario.ca

BDDI is already helping physicians and patients better manage diabetes.

“The fact is that people don’t understand how important an issue this can be,” says Elizabeth Spevack, Coordinator of Special Projects for the CAWC. “Small wounds are frequently dismissed or played down as simple annoyances. Most of the time, that’s exactly what they turn out to be. But every once in awhile, particularly for people with diabetes, they can end up being much, much more serious.”

The CAWC does not restrict its message to people living with diabetes. Canadians suffer from a variety of other chronic wound conditions brought on by low blood pressure and mobility issues, and even people in perfect health should understand the importance of proper wound management. But the 2.3 million Canadians living with diabetes make up what is perhaps the most important target audience for the wound care campaign, which is why the CAWC has made diabetes its particular focus for 2010.

Elizabeth Spevack says that the more people are aware of the dangers, the more care they are likely to take. “We want people with diabetes to be aware of how easy it is to develop cuts and blisters on their feet. So maybe they will wear shoes or slippers instead of wandering barefoot. And if they do suffer a cut or scrape, they will be on top of treating it right away. “Self-management is so critical with diabetes, from a health point of view and a quality of life point of view, and the CAWC is all about teaching people self-management.”

The work done by the CAWC and the objectives of the Ontario Diabetes Strategy are focused on achieving the best possible health outcomes for Ontarians.

Canadian Association of Wound CareA small cut on the bottom of the foot or a blister that gets infected. For most people, these are simple irritations. For someone with diabetes, however, a cut or blistered foot represents a serious health threat – one that can result in infection, possible amputation, or even death. This demonstrates the need for extremely careful disease self-management by patients, particularly in the area of foot care.

Diabetes can lead to a serious problem called neuropathy – nerve damage that causes a loss of sensation in the foot meaning that small

wounds can go unnoticed. Combine that with the fact that people with diabetes are more prone to skin conditions and infections, and you have serious foot problems waiting to happen. The sobering reality is that diabetes is the leading cause of limb amputation that

is not the result of an accident. People with diabetes are 15 to 40 times more likely to require lower-limb amputation than the rest of the population.

Given this reality, the Ontario Diabetes Strategy is committed to informing people with diabetes and their health care providers about the importance of foot care, wound prevention, and proper wound management. An important partner in this mission is the Canadian Association of Wound Care (CAWC).

The CAWC is a non-profit organization of health care professionals, researchers, corporate supporters, patients and caregivers dedicated to the advancement of wound care in Canada. Formed in 1995, the CAWC has worked to enhance the skills of health professionals and the knowledge of the public in the areas of wound prevention and wound management.

Clinical Lead for ODSThe Ontario Diabetes Strategy will be issuing an Expression of Interest for a Clinical Lead to take on a major role for at least one-year in providing advice and guidance as we move further into implementation.

The successful candidate will provide leadership across the province by:

• Supporting the province’s Regional Coordination Centres in facilitating the coordination of clinical diabetes care between Diabetes Education Centres, primary health care providers working in the community and other related services

• Supporting Regional Primary Care and Specialist Leads to build awareness and adoption of evidence-based guidelines and new information technology

• Chair a provincial committee that will provide support to the ministry

• Providing advice to the Ontario Diabetes Strategy project team on key implementation initiatives.

The Expression of Interest opportunity will be posted in September 2010 on the provincial government’s Stand up to Diabetes website.

The successful candidate will be expected to start in the Clinical Leadrole in November 2010.

Interested physicians are invited to visit the ministry websiteontaro.ca/diabetes in mid September to view the posting.

The Ontario Diabetes Strategy helps people with diabetes and meets the needs of those who are at high risk of developing it.