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Cardio-Vascular Disease and Diabetes Allied Health Education Package

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					• Why is the program needed? • What Information will be covered over the next couple of days? • Who is the target audience? • How will program delivery continue into the future?

• Formation of the “Diabetes Allied Health Task Group” by Health Advisory Unit Queensland Health
– Chaired by Principal Allied Health Adviser (3234 1386)

• Phase 1 - “Diabetes Guidelines” Recommended by Task Group
– Developed by Jackie Nankervis, Health Advisory Unit (3225 2328) – Now developing CVD Guidelines

• Phase 2 - Implementation of the Diabetes Guidelines
– Train the Trainer Education Sessions Contracted to the National Heart Foundation in association with Diabetes Australia Queensland – CVD Guidelines training to be explored once the guidelines are developed

• Phase 3 - Sustainable Resource for Diabetes & CHD Guidelines being developed by National Heart Foundation
– In association with Diabetes Australia Queensland – With Ongoing Management by Health Advisory Unit - Ian Callow (3234 1157)

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Improve the capacity of the health system to deliver, manage and monitor services for the prevention of diabetes and the care of people with or at risk of diabetes Prevent the delay the development of Type 2 diabetes Improve health related quality of life and reduce complications and premature mortality in people with Type 1 and Type2 diabetes

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Achieve long term maternal and child outcomes for gestational diabetes and for women with pre-existing diabetes equivalent to those of non-diabetic pregnancies Advance knowledge and understanding about the prevention, delay, early detection, care and cure of Type 1, Type 2 and gestational diabetes

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Screening,education and promotion services in National Priority and Key State Service Areas to meet agreed benchmarks Demonstrated progress toward achieving health outcomes in National and State Priorities for Aboriginal and Torres Strait Islander Health Reduction in the prevalence and incidence of smoking in the general population; increased community participation in exercise

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Increased proportion of the population with eating behaviours consistent with the NHMRC Dietary Guidelines for Australians (1992) Reduced prevalence of high blood pressure and high cholesterol in the general population

EVIDENCE (I),(II),(III),(IV)

INDICATORS DATA COLLECTION

PLAN

GUIDELINES STRATEGY

• Reduced rate of increase of diabetes mellitus, its health impact on the Queensland population, and its associated health system cost.

• PREVENTION • EARLY DETECTION AND MANAGEMENT

• Increase community participation in regular physical activity • Increase the proportion of the population with eating behaviours consistent with the NHMRC Dietary Guidelines for Australians (1992)

• • • •

Behaviour change Health promoting environments Communication and education Environmental/policy/ behavioural • Training • High risk and identified groups

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• • •

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Age-standardised incidence and age-specific prevalence rates of diabetes Incidence rates for CHD Prevalence of overweight and obesity Rates of non-participation in regular sustained moderate aerobic exercise Prevalence of a high fat diet Awareness of the early symptoms of and risk factors for diabetes

•

Access to factors which maintain health: – Opportunities for increased physical activity – availability and access to healthy food choices – adoption of health promoting organisational policies

• Develop individualised Plans • Optimal psychological adjustment • Glycaemic control • Normal growth & development

Paediatric Endocrinologist Paediatrician/Physician

General Practitioner

Diabetes Educator, Dietitian, Mental Health Worker

• • • •

Specialised hospital medical care Glycaemic Control Expert advice Screening

• Diabetes control and adjustment (3 monthly) • Postpubertal adolescents who have had diabetes for two years • Prepubertal children who have had diabetes since early childhood

 Consistent clinical management guidelines  Optimal psychosocial adjustment  Optimal metabolic (glycaemic) control

• Specialised hospital medical care • Glycaemic control • Expert advice • Screening • Tailored care for people who have special needs

 Endocrinologist/physician/general practitioner  Diabetes educator  Dietitian  Podiatrist  Health psychologist or social worker  Client with diabetes

• General Practice Advisory Council - Standard Care Pathway for Diabetes • Team approach across settings • Essential management and referral steps • General practice preferred care coordinator

Annually review/evaluate
– effectiveness of the care provided – signs of complications

DEVELOPMENT AND IMPLEMENTATION OF EVIDENCE BASED GUIDELINES TO DIRECT DIABETES RELATED SERVICE PLANNING AND DELIVERY

• Screening activities • Development and implementation of clinical care pathways in hospital • Management • Implementation of education guidelines • development of guidelines for – impotence among males – urinary incontinence among females • Human resources for implementation

REDESIGN OF SERVICES TO BE COLLABORATIVELY PLANNED AND DELIVERED AND WHICH ENSURE ACCESS TO PEOPLE AT NEED

• Role delineation • Provider recall of patients • Patient access to services as per guidelines • The collection of minimum data set across providers • Implementation of collaborative service models for the management of diabetic retinopathy (local diabetes network groups)

SERVICE PLANNING AND DELIVERY FOCUSSED ON ENHANCING THE CAPACITY OF PEOPLE TO PREVENT DIABETES OR OPTIMALLY MANAGE THE DISEASE IF PRESENT

• Social, behavioural and environmental determinants of health • Raise community awareness of diabetes • Incentives for people with diabetes • Investigate the effectiveness of brief interventions in promoting optimal management and healthy lifestyle choices

INFORMED AND NETWORKED DIABETES SERVICE PROVIDERS

• Training for health professionals • Indigenous health workers trained in diabetes education • Support service providers in implementing clinical management guidelines by automating care plans

INFORMATION SYSTEMS IN PLACE TO DIRECT EVIDENCE BASED CLIENT MANAGEMENT

• Diabetes - mandatory field on hospital admission form • NDOQRIN minimum data set • Access to healthy, affordable food • Incidence and prevalence of diabetes and its risk factors • Adverse outcomes of management

RESEARCH INFORMS SERVICE PLANNING AND DELIVERY

• Progressing knowledge of effective diabetes prevention and management interventions, particularly among high risk groups

• Reduced mortality associated with Diabetes • Reduced prevalence of Diabetes related complications • Enhanced quality of life for people with Diabetes • Reduced prevalence of risk factors for complications in people with Diabetes

Podiatry
Dietetics Diabetes Education

• Membership of the Australian Diabetes Educators Association

• Working towards or fulfilled the requirements of the Australian Diabetes Educators Association to be considered a diabetes educator • Qualifications

• Has undertaken an appropriate level of education • Role is to support the person with diabetes and the Diabetes Educator to achieve optimal health outcomes.

• Patient rights • Self referrals
– – – – Consistency Accessibility Patient autonomy Deterioration of presenting health problems

– – – – – – – – –

Initial diagnosis of diabetes Diagnosis of impaired glucose tolerance Change in the management of diabetes Change in physical status Psychological changes Social changes Annual review of clients People at high risk for developing diabetes Gestational Diabetes Mellitus

• Refer to flow Chart - Appendix 2

– – – – – – – – –

Newly diagnosed Changes to management/treatment Development of complications Assistance with blood glucose monitoring technique Review/assessment of those that do not access the service on a regular basis Knowledge and educational needs Assessment of complications Clinical indicators outside normal parameters for psychological wellbeing reasons For social wellbeing reasons

• Criteria that would restrict group education sessions • Criteria limiting the benefits to the individual within group education sessions

• Standards of professional practice • Indigenous health workers • Flexible competencies • Education Elements

Podiatry
Diabetes Education Dietetics

• Achieve and maintain optimal nutritional status for clients • Minimize the risk of short and long term complications and • Promote optimal patient wellbeing.

• • • • •

Outcome focused Consistent with evidence based approaches Both treatment and prevention of disease Professional standards and best practice guidelines Promote a self-management philosophy.

• Mandatory • Highly Desirable

– – – – – – – – – – – – –

Initial diagnosis or impaired glucose tolerance Recent change in management HbA1c  8% Episodes of uncontrolled glycaemia Dyslipidaemia Obesity – BMI > 30kg/m2 Pregnancy / Intention to become pregnant Gestational Diabetes Renal complications / Nephropathy Active comorbidities e.g. recent MI, worsening CVD Concurrent medical conditions Sudden unexplained weight loss or weight gain People with recognised risk of developing diabetes23 Annual review of client if not seen within 1 year

– – – – – – – – –

Non English speaking – requiring interpreter Impaired vision or hearing Episodes of uncontrolled glycaemia HbA1c 8% Obesity - BMI 30Kg/m2 Nephropathy Gestational Diabetes Behaviour not conducive to group learning Any patient with type 2 diabetes who requires insulin and is experiencing difficulty in controlling BGL – Active comorbidities – Concurrent medical conditions

• To achieve and maintain optimal nutritional status • To minimise the risk of shortterm and long-term complications • To promote optimal client wellbeing • Metabolic Control
– Blood Glucose Control – Blood Lipids – Blood Pressure

• Achieve And Maintain Body Fat Loss In People With A BMI  27 Kg/M2 Or Waist >102cm (Male) Or >88cm (Female)25 • Achieve and Maintain Positive Lifestyle Behaviour Changes
– Nutrition – Physical Activity
– Psychosocial factors

HbA1c  8% Newly diagnosed diabetes or impaired glucose tolerance Obesity – BMI > 30kg/m2 Episodes „unsafe‟ hypoglycaemia or hyperglycaemia Active comorbidities e.g. recent MI or worsening CVD (unstable angina, dyslipidaemia (ongoing, not improving)) – Nephropathy – Any patient with Type 2 Diabetes who requires insulin and is experiencing difficulty in controlling BGL‟s – Gestational Diabetes – – – – –

• Standards of professional practice • Level of care • How to use the guidelines – Select the elements – Evaluates results – Negotiates goals – Implements intervention/education strategy • Tables of Elements • Flexible competencies

Diabetes Education
Dietetics Podiatry

• Maintenance of foot health • Maintenance of mobility • Prevention of complications to the feet • Decrease the level of morbidity and amputations

• Mandatory • Highly Desirable

• Lower Limb Assessment Pathway (Page 6)

and

Referral

• Annual Foot Assessment • Foot Care and Health Promotion • Requires Podiatry Referral

History of – Previous foot ulceration – Previous partial or total foot amputation – Poor ability to heal injured skin within normal time frame – Intermittent claudication – Rest pain – Neuroarthropathy – Neuropathic symptoms

Clinical Signs of: – Foot ulcer – Foot abnormality – Skin pathology – Warm oedematous foot – Peripheral neuropathy – Peripheral vascular disease – Gait abnormalities, unsteadiness or change of gait – Muscle wastage in the lower limb – Restricted joint range of motion

• • • •

Who? What? When? Why?

• Dermatological – Wound classification and management – Nail management • Vascular • Neurological

• • • •

Biomechanical Morphological Footwear Education – Individual or group

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Standards of professional practice Risk categorisation Level of service delivery Assessments and managements Flexible competencies


				
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Lingjuan Ma Lingjuan Ma MS
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