National Diabetes Work Programme
2014/15
Citation: Ministry of Health. 2014. National Diabetes Work Programme 2014/15. Wellington: Ministry of Health.
Published in October 2014
by the Ministry of Health
PO Box 5013, Wellington 6145, New Zealand
ISBN 978-0-478-42871-1 (online)
HP 5966
This document is available at www.health.govt.nz
This work is licensed under the Creative Commons Attribution 4.0 International licence. In essence, you are free to: share ie, copy and redistribute the material in any medium or format; adapt ie, remix, transform and build upon the material. You must give appropriate credit, provide a link to the licence and indicate if changes were made.
Contents
Overview and vision 1
Overview 1
Vision 1
Role of the Ministry of Health 2
Key principles of the National Diabetes Work Programme 2
National Diabetes Work Programme 2014/15 3
Prevention 4
Identification 5
Management 6
Enablers 7
Monitoring 8
Quality standards for diabetes care 9
Basic care, self-management and education 9
Management of diabetes and cardiovascular risk (extensive guidelines available) 9
Management of diabetes complications (extensive guidelines available) 10
While in hospital ... 10
Special groups 10
Additional information on Quality Standards for Diabetes Care 11
Prediabetes advice 12
1 Identification of people with type 2 diabetes or prediabetes 12
2 Lifestyle management of people with prediabetes 13
3 Cardiovascular risk management 14
Notes 15
Reference 15
National Diabetes Work Programme 2014/15 iii
Overview and vision
Overview
This document outlines the work programme of the Ministry of Health (the Ministry) diabetes team for 2014/15, including key priorities and the initiatives and objectives to achieve those priorities. It also shows the links across the Ministry’s various teams and work programmes and how those links contribute to the diabetes team’s priorities.
The National Diabetes Work Programme brings together the work of the Ministry, National Diabetes Service Improvement Group (NDSIG), Health Quality & Safety Commission, district health boards (DHBs) and primary health organisations (PHOs) to implement the Government’s priorities for diabetes.
Non-communicable diseases such as diabetes, cardiovascular disease and cancer are the leading causes of mortality in New Zealand. The Ministry will work closely with the social sector and other sectors to influence New Zealanders’ decisions about how to improve their own health. The Ministry continues to seek to prevent the onset and impact of non-communicable diseases through more regular health checks relating to diabetes and cardiovascular disease and the risk factors for both these diseases.
Vision
People living with diabetes are regarded as leading partners in their own care within systems that ensure they can manage their own condition effectively with appropriate support.
Health services for people with diabetes in New Zealand will be high-quality, patient-focused and integrated across the health continuum from prevention to tertiary care. In this way, they will reduce the diabetes burden and enable optimum health outcomes.
Role of the Ministry of Health
The Ministry’s diabetes team is the essential link between diabetes policy and frontline service improvements for patients. Through its integrated work programmes across the Ministry and by coordinating with other government agencies, it provides national leadership and direction and supports local voices championing good-quality diabetes care.
The Ministry’s diabetes team works with the National Diabetes Service Improvement Group (NDSIG), a Ministry-funded group of experts, whose members include health consumers.
Its current key workstreams focus on:
· prevention and prediabetes
· complications of diabetes
· inpatients with diabetes
· workforce requirements and development
· health system performance
· self-management
· patients with type 1 diabetes, and children and young people.
Key principles of the National Diabetes Work Programme
The aim of the work programme is to focus service delivery on enhancing care and quality of life for people with diabetes. The work programme assumes that the focal point of care remains in primary care and the community setting, and that this work is supported by integrated primary health care teams and specialist health services.
The work programme follows three key principles:
1 prevention
2 identification
3 management.
These key principles are underpinned by enablers and monitoring to support the implementation of the work programme.
Work programme goals are to:
1 prevent: limit and reduce the risk of developing diabetes
2 identify: reduce the risk of developing complications for those New Zealanders with diabetes
3 manage: reduce the risk from complications of diabetes where they exist
4 enable: support and develop systems to provide high-quality care for people with diabetes
5 monitor: continually improve diabetes services to ensure equity of access and quality care.
National Diabetes Work Programme 2014/15
Prevention
Being overweight significantly increases an individual’s chance of developing type 2 diabetes. The Ministry is coordinating several programmes of work looking at policies that influence lifestyle changes such as diet and physical activity.
Initiatives / DeliverablesMore Heart and Diabetes Checks health target / · 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.
Evaluation of a prediabetes pilot at Albert Street Medical Centre / · Contract for the evaluation of the prediabetes programme at Albert Street Medical Centre.
· Distribute lessons learnt following completion of the evaluation.
· Develop and distribute options to make the model transferrable to other DHBs and their populations.
Prediabetes pilots / · Contract for three prediabetes pilots: Health Hawke’s Bay, Harbour Sport and Sport Bay of Plenty.
· Monitor contracts regularly.
· Distribute lessons learnt from pilots following completion of evaluation.
Māori pilots / · Conclude contract with the four Māori pilots.
· Evaluate the Māori pilots.
· Distribute lessons learnt following the evaluation.
Green Prescription / · Contract with providers to deliver Green Prescriptions.
Healthy Families New Zealand / · Begin 10 community pilot sites, which will reach approximately 900,000 New Zealanders.
Identification
As with other long-term conditions, early identification of diabetes allows people the opportunity to manage their diabetes before it becomes out of control. This management includes the early identification of complications such as foot ulceration, kidney damage and eye disease. When the early signs of damage to feet, kidneys and eyes are detected, active treatment can be undertaken to reduce the risk of amputation, renal failure, blindness, heart attack and stroke.
There are encouraging signs that the rates of these complications in people with diabetes have been falling over recent years.
Similarly there are new guidelines for gestational diabetes aiming for improved and earlier detection of both established and gestational diabetes.
Initiatives / DeliverablesMore Heart and Diabetes Checks health target / · 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.
Podiatry assessment tool / · Disseminate podiatry assessment tool to the health sector.
Retinal screening / · Update retinal screening guidance.
Chronic kidney assessment / · Disseminate chronic kidney consensus statement to the health sector.
Gestational diabetes / · Implement the guidelines.
Management
Effective management of diabetes and its complications gives people with diabetes the opportunity to lead normal lives. Management of diabetes includes prevention and early identification of diabetes-related complications.
Diabetes Care Improvement Packages (DCIPs) were introduced in July 2012 to replace the Get Checked programme. The introduction of DCIPs meant a change from a universally funded annual review process to a more tailored and individualised approach to diabetes care and management. This approach to diabetes care aims to empower people with diabetes to take an active role in their own care planning, and to ensure the delivery of patient-centred care.
The Ministry is working closely with DHBs to ensure the continued implementation of the DCIPs and related quality improvement in diabetes services.
Initiatives / DeliverablesInpatients with diabetes / · Provide national guidance on diabetes to inpatients.
· Provide guidance for care planning and discharge information.
· Provide national guidance on diabetes ketoacidosis.
· Provide guidance on insulin safety in hospitals, in conjunction with the Health Safety & Quality Commission.
Self-management support and education / · Disseminate guidance on diabetes self-management support to the health sector and key stakeholders.
Pilots for new model of care promoting shared care / · Three pilots, which began in May 2014, are trialling a model of care focused on patient empowerment and change management in primary care for people with chronic disease.
· These pilots are due for evaluation in August 2015.
· Lessons learnt will be evaluated following evaluation.
Podiatry / · Finalise the accreditation of training programme for community podiatrists and continue to work with Podiatry NZ on rolling out this programme nationally.
· Develop podiatry pathways.
· Develop podiatry models of care.
Retinal screening / · Revise retinal screening guidance.
· Develop a model of care for retinal screening.
Psychology / · Investigate the Diabetes Attitudes Wishes and Needs (DAWN) study to support people with diabetes and their whānau.
· Carry out a stocktake of assessment tools currently used to support psychological needs.
Enablers
Enablers such as service specifications provide the mechanism for making improvements in key priority areas of prevention, identification and management.
Initiatives / Deliverables20 Quality Standards for Diabetes Care (the Standards) / · Disseminate Standards to the health sector. These Standards will form part of DHB annual planning guidance and DHB service specifications.
Development of toolkit to support the Standards / · Develop toolkit to support the Standards. This will include academic rationale, innovation and implementation advice.
Gap analysis / · Conduct a stocktake of current services against the 20Standards to form a baseline for evaluation.
Service specifications / · Review DHB service specifications and, in the long term, develop an overarching DCIP service specification.
Framework for diabetes contracting / · Develop monitoring framework to support the Standards and outcomes.
Virtual diabetes register (VDR) / · Run the VDR for 2013 and 2014 then disseminate results to the health sector.
Improving the patient experience / · Conduct focus groups to identify areas where the patient experience could be improved.
Development of case studies / · Develop six case studies to highlight innovation and patient stories.
Ministry of Health website / · Update diabetes page.
Innovation resource sharing centre / · Update diabetes page on the Health Improvement and Innovation Resource Centre website.
Monitoring
By monitoring the health system, the Ministry gains a clear understanding of services being provided to people with diabetes. Based on this understanding, it can then provide support for quality improvements and share lessons learnt from stories of success across the health sector.
There is currently inconsistency and inequity in the access to, availability of and quality of diabetes services between DHBs and PHOs. These issues will be addressed using the following tools and frameworks.
Initiatives / DeliverablesMore Heart and Diabetes Checks health target / · 90 percent of the eligible population will have had their cardiovascular risk assessed in the last five years.
DHB annual plans / · Review and agree timeframes and deliverables against advice provided.
DHB annual planning advice / · Develop annual planning advice for 2015/16.
Quarterly reporting (PP20) / · Monitor progress of DHBs against annual plan deliverables.
DHB visits / · Visit DHBs six monthly.
Health Safety & Quality Commission – Diabetes Atlas of Variation / · The Atlas, shortly to be published, shows many diabetes metrics by individual DHB.
· The Atlas will be used as a quality improvement tool to measure progress in quarters 2 and 4.
Reporting to the World Health Organization and Organisation for Economic Co-operation and Development (OECD) / · Collate diabetes-related data to inform reporting to the World Health Organization and OECD.
Ambulatory sensitive hospitalisation (ASH) rates for diabetes / · Collate rates and trends of ASH and report back to DHBs as a quality improvement measure.
Clinical governance / · Identify and disseminate examples/models of successful local clinical governance.
Coding of prediabetes / · Share advice with the health sector.
Quality standards for diabetes care
For revision at end of 2016.
These Standards should be considered when planning your local service delivery. They provide guidance for clinical quality service planning and implementation of equitable and comprehensive patient- centred care – scaled to local diabetes prevalence. They should be read alongside the New Zealand Guidelines Group (NZGG) guidelines and other guidelines that highlight specific clinical expectations. These Standards are specific to people with diabetes; those identified with prediabetes should be managed in accordance with the prediabetes advice provided by the Ministry of Health (2013).
Basic care, self-management and education
1. People with diabetes should receive high-quality, structured self-management education that is tailored to their individual and cultural needs. They and their families and whānau should be informed of, and provided with, support services and resources that are appropriate and locally available.
2. People with diabetes should receive personalised advice on nutrition and physical activity, together with smoking cessation advice and support if required.
3. They should be offered, as a minimum, an annual assessment for the risk and presence of diabetes- related complications and for cardiovascular risk. They should participate in making their own care plans, and set agreed and documented goals/targets with their health care team.
4. They should be assessed for the presence of psychological problems, with expert help provided if required.
Management of diabetes and cardiovascular risk (extensive guidelines available)
5. People with diabetes should agree with their health care professionals to start, review and stop medication as appropriate to manage their cardiovascular risk, blood glucose and other health issues. They should have access to glucose monitoring devices appropriate to their needs.
6. They should be offered blood pressure, blood lipid and anti-platelet therapy to lower cardiovascular risk when required in accordance with current recommendations.
7. When insulin is required, it should be initiated by trained health care professionals within a structured programme that, whenever possible, includes education in dose titration by the person with diabetes.
8. Those who do not achieve their agreed targets should have access to appropriate expert help.