Overview
The Queensland Strategy for Chronic Disease 2005-2015 identifies Type 2 diabetes as a priority for action in the prevention and management of chronic disease. Queensland Health recognises that diabetes is a major avoidable health problem attributing to morbidity and mortality which significantly increases the cost of hospital care. As part of the systems and local approach to addressing the burden of disease associated with Type 2 diabetes, the Divisions network has identified the key role the primary health care sector plays in the coordination of early intervention, prevention and management of the disease.
The Type 2 Diabetes Standard Care Pathway project is a statewide initiative focusing on the development of an electronic resource to support a consistent approach to the management of Type 2 diabetes in Queensland.
This project continues to link with the work being undertaken by the Statewide Diabetes Clinical Network and support the implementation of the Standard Care Pathway for Type 2 diabetes in General Practice and Community Nursing.
Objectives
This project will build the capacity of the primary health care sector to improve the management of Type 2 diabetes within the primary care setting through achievement of the following primary objectives:
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To develop strategies to support the implementation of the Standard Care Pathway for Type 2 diabetes with General Practice and Community Nursing;
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To improve partnerships between General Practitioners, Divisions of General Practice, QLD Health Community health, Nursing Agencies, Allied Health, Pharmacists and others involved in the care of patients with diabetes.
Program Detail
In 2005, Queensland Health initiated the redevelopment of the Standard Care Pathway for Diabetes (2000). In late 2006, General Practice Queensland circulated the updated Diabetes Standard Care Pathway to seek feedback on the usefulness of the information and format with General Practitioners, Practice Nurses, Pharmacists and Division staff. Feedback indicated that the utilisation of the Standard Care Pathway would be problematic in General Practice. While overall comments supported the usefulness of the information provided and the care pathway, it was widely noted that there was limited use of the poster format in the Practice setting.
In response to comments and feedback on the usefulness of the existing Standard Care Pathway tool, this joint project being undertaken by General Practice Queensland in conjunction with the Clinical Practice Improvement Centre (CPIC), QLD Health and the QLD Health Statewide Diabetes Clinical Network. The Project focuses on the development of an electronic resource to support a consistent approach to the management of Type 2 diabetes in Queensland.
The Statewide Diabetes Clinical Network recognises that the Standard Care Pathway will provide a statewide evidence based framework for the management of Type 2 diabetes in the primary health care setting. The Diabetes Standard Care Pathway is acknowledged and supported as a valuable resource, particularly for those Divisions and General Practices participating in the National Primary Care Collaboratives. In addition, approximately eight (8) of the eighteen (18) Divisions have identified the prevention and management of Type 2 diabetes as a key priority area through the Capacity for Local Partnerships Initiative (CLPI). There is a clear need for the Standard Care Pathway to be redeveloped into a format that facilitates effective utilisation in a Practice and community setting.
The implementation framework developed to support this project and achieve its objectives is outlined below:
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Establish a multi-stakeholder Diabetes Advisory Group to inform and guide the development of the resource. Membership comprises: General Practitioner, Practice Nurse, Diabetes Australia (QLD), Divisional reps, GPQ reps, QAIHC rep, QLD Health (CPIC, Diabetes Network Chair & Chronic Disease Coordinator) and the Pharmacy Guild of Australia (QLD).
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Undertake a focused systematic review of existing resources to support the implementation of evidence-based approaches to Type 2 diabetes.
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Facilitate a consultation workshop to seek targeted input by Divisions, General Practitioners and CHAG agencies on development of the online or electronic tool.
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Develop a practical resource (online or electronic) which details the information and referral pathway for the management of patients with Type 2 diabetes.
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Provide a workshop for Divisional Chronic Disease Program staff (18 Divisions). This is an opportunity to provide a workshop-style education and promotion session for Chronic Disease Program staff on the resource developed and identify opportunities to integrate through existing programs and initiatives such as: Connecting Healthcare in Communities (CHIC), Capacity for Local Partnerships Initiative (CLPI), National Primary Care Collaboratives (NPCC), etc
Achievements
January 2008 – June 2008
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The multi-stakeholder Type 2 Diabetes Standard Care Pathway Advisory Group was formed in early 2008 and has been meeting regularly to advise on stages of the Pathway development. The advisory group comprises representatives from General Practice Queensland, the Divisions network, GPs, the Diabetes Clinical Network, Diabetes Australia Queensland and the Pharmacy Guild.
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Consultation with CHAG members at key points in the Pathway development.
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The Griffith University review was completed, identifying the barriers and enablers to the uptake of clinical guidelines in General Practice.
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A consultation workshop attended by key stakeholders was held in May 2008 to discuss the Type 2 Diabetes Standard Care Pathway format:
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Representatives from the Divisions network, GP, CHAG, Diabetes Australia Queensland provided input to the layout for the standard care pathway which would include a pathway to identify the process for responding to the needs of an individual ‘at risk’ of Type 2 Diabetes. This was facilitated by staff from the Clinical Practice Improvement Centre (CPIC);
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Web designers were also in attendance to identify the implications for the web based application;
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From this workshop necessary inclusions and amendments were identified. E.g. In addition to the ‘at risk’ pathway, Medicare item numbers were to be added;
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A further consultation workshop for end-users is planned to evaluate the effectiveness of the electronic resource with the identified amendments from the initial workshop.
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Following the initial workshop, a pathway representation was developed by the designers:
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This pathway representation, presented as a poster, provides a practical resource for use in a clinic setting. It contains the evidence based information for management of individuals ‘at risk’ or diagnosed with Type 2 Diabetes;
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The Advisory Group and other key stakeholders were consulted about this pathway representation and further refinements were undertaken;
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Once consensus was reached, the pathway representation was then developed into the electronic resource;
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The draft web based tool requires further refinement and consultation before being uploaded onto the website;
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It is anticipated that the electronic resource will be available for trial by the end of August;
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Final endorsement is also required from QH and the Diabetes Clinical network before the Tool can be uploaded onto the website.
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Discussions were held regarding possible links to the Map of Medicine which is a decision-making tool across a range of disease areas. This tool is being investigated by Queensland Health for use in the future.
Resources
Type 2 Diabetes Standard Care Pathway website: www.t2d.com.au
We would like to encourage Divisions of General Practice to disseminate this information and to support the uptake of this tool with General Practitioners, Practice Nurses and Allied Health Staff. To assist with this, please click for a coloured flyer (2MB) or a grayscale flyer (100KB) to email or fax to General Practices.
Click here to download the Type 2 Diabetes Standard Care Pathway Project fact sheet.
Links
RACGP diabetes clinical resources
Feedback
Katie Griffin
Program Coordinator – Chronic Disease
Email: kgriffin@gpqld.com.au
Phone: 07 3105 8300