Will we be able to tell if an increased investment in diabetes care is improving patients’ health?

Only if we have meaningful data collection systems in place, suggests this latest update from the Primary Health Care Research and Information Service.


Will diabetes projects deliver value for money?

Katrina Erny-Albrecht writes:

Diabetes is clearly on the Australian Government’s radar with the recent announcement that Diabetes Australia will receive close to a billion dollars ($909,054,841) to deliver the National Diabetes Scheme, and McKinsey Pacific Rim will receive approximately $34 million to undertake implementation of the Coordinated Care for Diabetes pilot.

With an estimated 1.5 million Australians having diabetes (including all types, diagnosed and undiagnosed), and diabetes prevalence growing faster than any other chronic disease in Australia, there is a growing sense of urgency surrounding this epidemic.

Diabetes is a treatable but chronic condition associated with numerous complications, including cardiovascular and kidney diseases, blindness and limb amputation.  Its effects are far reaching, as diabetes affecting one family member often impacts on the lives of those providing much needed support.

So what will these two programs deliver for the money?

The National Diabetes Scheme has five focus areas: raising awareness, improving prevention, detection, and management, and finding a cure.1

The general practice-based Coordinated Care pilot program (also known as the Diabetes Care Project, DCP) is already underway, and aims to find new ways of providing multidisciplinary education and care that are more flexible and better coordinated.

Four key changes are being assessed: a new Care Facilitator role, an education and training program, a new chronic disease IT tool to support information sharing (cdmNet), and a new funding model for provision of care.

General practice has a central role in diabetes care as currently 10% of general practitioners’ patients have diabetes.

Having diabetes on the radar is thus important for primary health care, but how do we know that the money is well spent and the people well served?

Ultimately both programs aim to improve care and reduce the impact of diabetes on the immediate and future health of those at risk or already affected; therefore it will be important to have information on meaningful outcomes such as incidence of complications and newly diagnosed diabetes, changes in blood glucose control etc.

The Coordinated Care for Diabetes program includes a focus on individual outcomes, and the National Diabetes Scheme proposal includes generation of a report card to inform Australians, much like the school report cards used to guide education, showing us where there is progress and where improvement is required.

However, as recently discussed in our PHCRIS RESEARCH ROUNDup, generating a nationally relevant report card will in itself require a new level of collaboration and investment.

Other studies which employ the report card approach, such as the Bettering the Evaluation and Care of Health (BEACH) study and the Australian Diabetes Obesity and Lifestyle Study (AusDiab) have much to teach us; however, they are insufficient to provide us with the information we need to assess the value of new programs at a population level.

This latest allocation of funds reflects the substantial burden of diabetes, and acknowledges the importance of coordinating care for those affected.

It is hoped that the establishment of a coordinated, nationwide data collection system to monitor meaningful outcomes among ‘real world’ patients will also be funded to guide future and ongoing program development, and to maximise this opportunity to make a difference.

• Katrina Erny-Albrecht is Research Fellow at PHCRIS. This PHCRIS publication featured in the 27th February 2014 edition of PHCRIS eBulletin, available at phcris.org.au/issue/27_February_2014.

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