A regional diabetes database improves Type 2 diabetes outcomes in general practice
Type 2 diabetes is on the increase in the Australian population, and is more prevalent in
areas of lower socioeconomic status according to the AIHW. In the New England region
of northern NSW, the percentage of people with diabetes registered on the National
Diabetes Services Scheme (NDSS) is 5.5%, compared to the national average of 4.9%.
Coupled with a shrinking general practice workforce across the region, efficient and
effective management of diabetes is a salient issue in primary health care for our
region. Between1997-2014 the New England Diabetes Program database provided an
annual review reminder service for over 3,000 patients with diabetes in the region, and
also collected a comprehensive array of results from each annual review that was
attended and reported by their doctors. The objective of this study was to evaluate the
efficacy of the database in maintaining patients’ diabetes measures at optimal health
targets stipulated by Diabetes Australia. The results of the evaluation suggest that a
regional diabetes database operated by an external organisation on behalf of the
region’s general practitioners may be helpful in maintaining patients’ HbA1c, cholesterol
and blood pressure at the recommended target levels for optimal diabetes
management. It is hoped that organisations such as the Primary Health Networks could
operate similar chronic disease databases including, cardiovascular and chronic kidney
disease as well as diabetes.
Management of Type 2 diabetes requires long-term monitoring of patients to minimise
progress of the disease. Diabetes management is a time-consuming task for general
practitioners, and can be compromised if patients do not attend review appointments.
Use of a database to generate appointment reminders and collect annual diabetes
review data can provide feedback to patients and doctors about the efficacy of their
diabetes management strategies.
This study examines the impact of annual diabetes review appointments on diabetes
markers for 3,000 patients living in regional north-western NSW. De-identified annual
diabetes review records were extracted from the New England Diabetes Program
database curated by the New England Medicare Local, 1997-2014.
Analysis of HbA1c, cholesterol, blood pressure, BMI and waist circumference measures
was performed to assess whether annual reviews assisted patients in reaching and
maintaining national target recommendations for diabetes management goals over their
time in the Program.
The cohort showed an increase in the number of people with HbA1c, cholesterol and
blood pressure measures at or below target over time. BMI and waist circumference
appeared resistant to change over time.
The results of the evaluation suggest that a regional diabetes database operated in
partnership with the region’s general practitioners may be helpful in maintaining
patients’ HbA1c, cholesterol and blood pressure at the recommended target levels for
optimal diabetes management. The Primary Health Networks could operate a chronic
disease database monitoring the cluster of chronic life-style diseases: diabetes,
cardiovascular and chronic kidney disease.