Diabetes

Achieving Targets in Diabetes Care

Qualitative Research

Diabetes poses a significant burden to patients and the healthcare system and the Australian government included diabetes as a National Priority Area in 1996. Reaching target levels for HbA1c, lipids and blood pressure are crucial in the appropriate treatment of people with diabetes, yet less than one in seven people with diabetes are reaching these stated targets. The Pharmaceutical Alliance has an ongoing interest in Quality Use of Medicines (QUM) and views diabetes management as a therapeutic area where the principles of QUM can be applied to improve patient management and health outcomes. Following on from other QUM projects The Pharmaceutical Alliance is currently focussing on a project called 'Achieving Targets in Diabetes Care.' To gain an understanding of the barriers to achieving the recognised targets The Pharmaceutical Alliance commissioned qualitative research which was carried out in two stages;

Phase 1 - 12 GPs, 4 endocrinologists, 6 diabetes nurse educators

Phase 2 - 20 people with known diabetes

Outcomes - five key barriers:

1. Patient – attitude to diabetes; awareness and understanding of  treatment targets; non compliance with lifestyle changes and  medicines; lifetime challenge of chronic disease; gaps in information
   
2. Practitioner – flexible attitudes towards targets; difficulty in keeping up to date; motivation of patients to make changes or to adhere; limited consultation time; shortage of/inability to refer to educators
   
3. Medical – co-morbidities; diabetes complexity and complications; polypharmacy
   
4. Systemic – problems in the treatment cycle or medical system
   
5. Social/economic – cultural factors; cost of medicines and GP visits
   

The Pharmaceutical Alliance presented the outcomes of this research in August 2006 at the Australian Diabetes Society (ADS) and Australian Diabetes Educators Association (ADEA) Annual Scientific Meeting: ‘Understanding why Australians with type 2 diabetes are not achieving treatment targets’ and at the International Diabetes Institute/Diabetes Australia VIC seminar in May 2007. The summary report of the research was published May 2007.

Electronic Decision Support Demonstration Project 

One of the barriers identified through the research was effective patient management given the complex nature of Type 2 diabetes and its complications; the difficulties in accessing up to date and relevant guideline information, the need to view the patient data holistically and in context, and the need to align GP and patient views around targets and individual goals. The Pharmaceutical Alliance drew on learnings from a former project, the Integrated Care Program (ICP), and undertook to develop an Electronic Decision Support Software (EDSS) for health care practitioners to use during consultations with their patients with diabetes. It is envisaged that use of the EDSS tool will increase accessibility to evidence based guidelines and patient information, thereby promoting an informed and proactive treat to target approach. The software will be trialled with GPs in NSW mid to late 2008.