Improving Diabetes Management - Sunshine Coast Division of General Practice (SCDGP), Australia

Improving Diabetes Management

Improving Diabetes Management Program

“Occasions when two or more professions learn with, from and about each other to improve collaboration and the quality of care”^[1]^.

The Sunshine Coast Division of General Practice has received endorsement to coordinate and deliver a sustainable program that will provide professional development incorporating Inter-Professional Learning for health professionals in type 2 diabetes management. The program is a result of audit and review activities specific to the Sunshine Coast Cooloola Health Service District that was undertaken in 2007 and 2008.

This program aims to contribute to improving health outcomes for patients with type 2 diabetes by promoting

Risk modification
Encouraging active self management
Improving integration and coordination of care
Workforce up skilling through structured education
Improving patient satisfaction
Targets to guide management

To achieve this, the project will take on four phases:

Phase 1: The selection and engagement of twelve general practices to participate in the program, with six in the first wave and six in the second wave.

Phase 2: Installation of a clinical audit tool (CAT) that will extract data within your practice. This will assist you in gathering information about your active patients and enable the collection of de-identified data specific to diabetic patients. We will also undertake a practice survey to help identify needs. GP’s will also be asked to nominate and track three of their patients with high needs.

Phase 3: Provide assistance with data management and targeted IDM based on the results of the practices’ survey and data extraction. Improved data systems will assist in the management of your diabetes patients and assist in improving efficacy within your practice.

Phase 4: Evaluation of the program and tracking of clinical data retrieved throughout the program. Feedback reports will be provided to the practice through the duration and conclusion of the program. Analysed results will enable the assessment of the effectiveness of educational interventions for Type 2 diabetic patients with complex conditions.

In brief, it is envisaged that the project will evolve with the following steps:

1. Recruit practices that meet the selection criteria of the IDM program;

2. Practice participants encouraged to attend IDM introductory session;

3. Install CAT at practice site, download initial data extraction; provide feedback and education in the functionality of the Clinical Audit Tool;

4. Analyse baseline data to identify complex patients and opportunities for improvement in data management and quality;

5. Conduct practice survey; evaluate, provide feedback and recommendations that will assist in proactively managing complex patients;

6. Develop and facilitate educational activities as identified by the practice survey activity;

7. Ask GP to nominate three high needs patients and practice nurse to undertake pre and post self-management survey supplied by the program;

8. Coordination of providers to encourage teamwork and shared knowledge;

9. Analyse the collated data to determine efficacy of interventions in improving the health outcomes of type 2 diabetes mellitus patients residing in the Sunshine Coast Cooloola Health Services District.

The Sunshine Coast Division of General Practice is committed to assisting in improving the professional development of health professionals and improving patient health outcomes in the Southern Cluster of the Sunshine Coast and Wide Bay Health Service District and look forward to supporting all participating practices and their staff engaged for the duration of the project.

[1]Centre for the advancement of inter-professional education, 2007

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