National Type 2 Diabetes Prevention Program

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National Type 2 Diabetes Prevention Program Powered By Docstoc
					 National
  Type 2
 Diabetes
Prevention
 Program
Why diabetes prevention?

• There is good evidence that diabetes
  can be prevented
• The burden of disease and cost to the
  economy are significant drivers to
  action
• General Practice is well placed to play a
  central role in any diabetes prevention
  program
Background

• The National Type 2 Diabetes
 Prevention program is an initiative of
 the Council of Australian Governments

• Part of the National Reform Agenda

• Federal and state strategies have been
 allocated funding

• Activity has begun across the country
Commonwealth commitment

Commonwealth Government commitment:
 $103.4M
  – Development of an Australian type 2 diabetes risk
    assessment tool
  – New Medicare item number to assess risk in 40-
    49 yo‟s
  – Patients at high risk can be referred by their GP to
    a local accredited Lifestyle Management Program
    (LMP)
  – Development of national LMP standards for
    accreditation
  – Divisions network funded to purchase and/or
    provide LMPs
 MBS Item 713 – diabetes risk review


Purpose:                          Patient eligibility:
                                  • 40-49 years of age
• To support general practice
  to address the health needs     • At “high risk” of diabetes as
                                    defined by the NRAT
  of patients 40-49 years of
  age who are at „high risk‟ of   • Has not already developed
                                    diabetes
  developing type 2 diabetes.
                                  • Has not had an item 717
                                    claimed in the past 3 years
MBS Item 713 – diabetes risk review
• Components of check
  – Review of the factors underlying the
    AUSDRISK „high risk‟ score
  – Updating patient history
  – Examinations and investigations
  – Initiating interventions where possible
  – Providing advice and information
  – Considering referral to an LMP
MBS Item 713 – diabetes risk review

• Role of PN, Aboriginal Health Workers or
  other health professionals in assisting
  GPs deliver item 713
  – Identification of eligible patients
  – Patient information collection
  – Information provision to patients
Medicare items processed from July
2008 to September 2008

• Victorian services under item 713


                737
• A total of 2850 services nationally
Relationship between MBS items

• A GP cannot conduct an item 713, if a previous 713
  has been conducted within the previous 3 years.
• A person who has previously accessed a 45-49 year
  health check (item 717), can only become eligible for
  a type 2 diabetes risk evaluation (item 713) when 3
  years have elapsed.
• A previous item 713 does not preclude an eligible
  person from accessing item 717 in relation to the risk
  of developing other chronic illnesses
   Relationship between items

Item 717 – 45-49 health check


     3 years        1 day




Item 713 – Diabetes risk review
 Lifestyle Modification Programs

• Randomised Control Trials have provided
  strong evidence that lifestyle modification
  can prevent or delay the onset of type 2
  diabetes.


• Nationally consistent service delivery will be
  facilitated by and accreditation process
  based on nationally agreed, evidence based
  LMP service standards.
National LMP Standards

• These core standards have been developed to
  guide type 2 diabetes prevention programs
  being implemented as part of the national
  diabetes prevention program.

• Diabetes prevention programs will be
  accredited if it can be illustrated that the
  program content and presentation meets the
  National LMP standards
What information will an accredited LMP
include?

• Risks of diabetes and their relationship to lifestyle
  risk factors
• Importance of regular diabetes screening
• Nutrition advice and education
• Physical activity advice
• Behavioral strategies to support the adoption and
  maintenance of lifestyle change
• Smoking cessation and alcohol reduction advice if
  required
• Information about community resources relevant to
  sustaining lifestyle change
What will an accredited LMP look like?

• Face to face delivery
• Group or individual sessions with groups no
  larger than 15 participants
• Minimum of 8 hours of contact time
   – Initial intensive phase of at least 4 months duration
   – End program follow up session at least 6 months
     after commencement of the program
• Providers must be able to illustrate their ability
  to meet core competencies outlined in program
  standards
Accreditation

• Accreditation will ensure that LMPs meet
  the National LMP Standards
• Only accredited LMPs will be able to
  claim a rebate for service delivery.
• Accreditation system is now in place.
• See becoming an accredited provider on
  the AGPN web site:
 http://www.agpn.com.au/site/index.cfm?display
 =38797
Accredited LMPs in Victoria

• Both „RESET your life‟ & Life! are accredited to
  deliver LMP services to patients 40-49 years

• Details of all accredited LMP providers to be
  uploaded onto AGPN web site within the next
  few weeks
LMP Patient eligibility

• 40 – 49 years or Aboriginal patients between
  15 and 54 years
• At “high” risk of diabetes as determined by
  the Australian type 2 diabetes risk
  assessment tool
• Have not attended a LMP previously
• Has had existing diabetes excluded
• Provided consent
• Referred by usual GP through 1 of 3 possible
  item numbers: 713; 717 or 710
  Start here   ↓
                                                                             Referral pathway /
                                Is your patient of
                                ATSI origin and
Is your client aged             15—54 years and
40-49 years?
                        NO
                                eligible for the ATSI
                                health check?                                decision support
                                                            Usual care including use
     YES                                              NO                                            NO
                                      YES                   of the Lifescripts suite
                                                            of resources
Is your patient of
                                                                             Is your patient at
ATSI origin and                 Item 710—Aboriginal and                      high risk of
eligible for the ATSI           Torres Strait islander health                                            Does your
                         YES                                                 developing
health check?                   check                                                                    patient
                                                                             diabetes as
                                                                                                         have
                                                                             defined by the       YES                       YES
                                                                                                         diabetes?
                                                                             Australian type 2
      NO
                                                                             diabetes risk
                                                                             assessment tool?
                                                           Item 717—                                         NO
Is your patient 45-49 years old &
                                                YES        45-49 year
eligible for a 45-49 year health check?
                                                           health check
                                                                                                   Discuss options and
                                                                                                   consider a referral to
      NO                                                                                           LMP if patient is
                                                                         If eligible               agreeable
                                          Does your
                                          patient have                   Item 713: Type 2
 Is your patient at ‘high       YES                             NO                                 Complete GP referral to
                                          diabetes?                      Diabetes Risk
 risk’ of diabetes as defined                                                                      LMP and provide
                                                                         Evaluation
 by the Australian type 2                                                                          referral to patient or
 diabetes risk assessment?                                                                         send directly to your
 (40—49 yrs)                                                                                       local LMP provider.
                                                                     Usual care including          See your local Division
                                                                     diabetes annual cycle         for details of your local
      NO        Does your patient                                    of care and GP                LMP services
                have diabetes?                 YES                   Management plan and
                                                                     team care
                                                                     arrangement
                   NO
LMP evaluation


•   Aim
•   On-line capture
•   Enrolment-mid-end point data
•   GP referral forms/LMP feedback forms
•   Why capture this data?
•   What can this data be used for – locally-state
    level - nationally
Service Delivery (LMP) funding

• 136 000 expected referrals over 3 years

• $210 subsidy per patient
• $50 co-payment
• $260 subsidy for patients with health care or
  concession cards.

• 3 scheduled payments to LMP providers ad
  program enrolment, completion of intensive
  phase and end program.
Web resources

• AGPN Prevention of type 2 diabetes program
  web site:
  http://www.agpn.com.au/site/index.cfm?display
  =35338

• DoHA: Type 2 diabetes risk evaluation
  http://www.health.gov.au/internet/main/publishi
  ng.nsf/Content/Diabetes-Risk_Evaluation