Diabetes Clinics in General Practice

DIABETES CLINICS IN GENERAL PRACTICE
The following are guidelines for the Practice Consultant Program. They will provide a framework to guide you and the Practice Nurse on how to develop a systematic approach to diabetes care and how to set up diabetes clinics within General Practice.
 
CHECKLIST 
  • Practice protocols for the care of diabetes
  • Systems for delivery of care
  • Roles and responsibilities on how patients should be managed
  • Customised education program for individual patients
  • Use of guidelines
  • Use of protocols
  • Use of templates
RECRUITING OF PATIENTS
  • GP referrals
  • Nurse referrals
  • Recalls using register
  • Recalls from Diabetes Clinic
  • Advertising (eg waiting room)  
ROLE OF PRACTICE NURSE

Diabetes Clinic Preparation
  • Selecting patients for diabetes clinic
  • Develop a letter in MD to send to patients
  • Medical Director templates
  • Procedures for reception staff to book patients
  • Patient information for GPs to hand out
  • Place article in patient newsletter
  • Advertising sign for reception (could do a diabetes education month)
  • Staff meeting with Drs, nurses and reception staff to go through how the clinic will operate and what needs to be done at each step in the process
  • Timing of clinic appointments (whole day, pension day, appointment schedule)
  • Set up appointment book for nurse
  • Conducts a clinical review  
ANNUAL CYCLE OF CARE ITEMS

Care Planning (MBS Items 721, 723, 725)
  • Review home glucose monitoring
  • Physical assessment (RBG, BP, micro albumin etc)
  • Lifestyle counselling (nutrition, exercise, smoking, alcohol)
  • Medication review
  • Allied Health and Specialist providers
  • Equipment forms
  • Forms for DAQ
  • Completion of notes
  • Printing of pathology forms
  • Add patient to recall  
ROLE OF THE GENERAL PRACTITIONER
  • Review the clinical information
  • Perform physical examination
  • Coding  
PATIENT
  • Self Management Interview (knowledge of condition, treatment and medication)
  • Patient survey
  • National Diabetes Services Scheme (NDSS)
  • Complete Diabetes Australia Registration form
  • Diabetes Australia FACT sheets
 
RESOURCES AND INFORMATION - available from the Sunshine Coast Division of General Practice -
  • Diabetes Hand Held Records
  • Patient Survey (Diabetes Assessment tool) taken from MD
  • Diabetes presentation Monash Division GP - putting the CDM MBS Item Numbers into Practice in Managing Patients with Diabetes.  Information on time frames in claiming TCA, GPMP, SIPs and incomes
  • The Australian Guide to Healthy Eating Poster
  • Food for Health brochure, Dietary Guidelines for Australian Adults
  • Novo Nordisk Diabetes Services "My Diabetes Record Book" for people who use Novo Nordisk insulin
  • Starting Insulin, Information for people with type II Diabetes (Novo Nordisk)
  • Self Monitoring Kit (contains pages for results, activity diary, medication checklist & food diary (Bristol-Myers Squibb)
  • Diabetes Australia - National Diabetes Week Resource Kit (includes Risk Assessment Tick Test pad, Health Professionals Information Sheet, three posters highlighting on Diabetes (available in six different languages)
HELPFUL DIABETES WEBSITES