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Detecting diabetes

Diabetes Tools PDF

Identifying the barriers to diabetes testing

A suggested method of identifying the barriers to diabetes care is to start by asking the following questions:

  • Is diabetes testing available? Does the practice have the knowledge and tools to provide testing?
  • Is diabetes testing appropriate? Are the right people getting the right tests at the right time?
  • Is diabetes testing accessible? Are the people that need testing able to access the service?
  • Is diabetes testing acceptable? Is testing culturally acceptable to your practice population?

Is diabetes testing available?

Focus: The practice has the knowledge and tools to provide testing.

Question: Has your practice considered the best way to identify and test people with undiagnosed diabetes?

Barriers to the availability of diabetes care

  1. No plan for identifying patients with undiagnosed diabetes
  2. Lack of recognition of the importance of early detection of hyperglycaemia
  3. Practical constraints on the practice e.g. time, resources

Tool A: Diabetes Action Plan

This tool may be useful for a practice meeting discussion in which all members of staff are present. This is a means of focusing the entire team on the importance of identifying people with hyperglycaemia. It provides a framework for discussing barriers to an effective system, and opportunity for identifying ways in which everyone can contribute to the process.

  Diabetes Action Plan

Is diabetes testing appropriate?

Focus: The right people getting the right tests at the right time.

There is a lack of evidence for benefit from population wide screening, therefore targeted testing of people at high risk for diabetes (see page 14) is considered the most practical use of resources.

Questions

Does the practice have a method for identifying people at high risk of diabetes?

Does the practice aware of which tests are considered the best for the diagnosis of diabetes?

Barriers to appropriate testing

  1. People with symptoms of diabetes are not being identified
  2. People at high risk of diabetes are not being tested
  3. People are not being testing as part of CVD risk assessment

Tools for overcoming barriers

Tool B: Guide to testing

All members of the team may be able to contribute to targeted testing of people for diabetes. The testing guide (tool B) provides information about how to appropriately test people, which test to use and when people should be tested.

  Testing Guide

Testing the right people

Place posters in the practice
A poster in the waiting room may be a useful way of raising awareness in patients of the risk factors of diabetes.

  Poster “Are you at risk of diabetes?”

Use your PMS system to help identify eligible people
The practice management system (PMS) is a useful means of identifying people based on recorded risk factors. As Māori or Pacific ethnicity is a risk factor for diabetes, the example provided in tool D provides a step-by-step approach to identifying Māori people over the age of 40 years. This search could be altered for other groups with a high incidence of diabetes.

  Set up PMS system alert

Set up a patient recall system
Once a patient is identified as being eligible for diabetes testing, an appointment needs to be arranged. For people who attend regularly, the patient notes can be ‘flagged’, and testing can be arranged at the next consultation. For patients who attend less frequently, contacting by mail or telephone may be more appropriate.

A recall letter should create an expectation the patient will attend, and inform the patient of the benefits of testing. Many people associate diabetes with classic symptoms of thirst and polyuria, and may not see the need for testing if they do not suffer from these symptoms. It is important to emphasise the message that a positive early diagnosis is likely to produce both immediate and long term health benefits.

  Patient recall letter

The bpac download “Why test me for diabetes?” may be useful for patients who have never considered they may have diabetes.

  Patient information “Why test me for diabetes?”

Is diabetes testing accessible?

Focus: The people that need testing are able to access the service.

It is often difficult to persuade people to take the time to attend for testing for an undiagnosed disease which they often do not want to know they have. This means we should make it easy to access the service.

Questions

Have you considered measures to overcome access barriers?

Do you promote the health benefits of early diagnosis of diabetes?

Do you follow up people who fail to attend?

Barriers to access for diabetes care

  1. Cost or perceptions of value
  2. Location of practice
  3. Getting time off work, requirements for child care and elder care
  4. Having to arrange an appointment and time spent getting tests
  5. Achieving fasting status
  6. Fear of testing or of having diabetes
  7. Prior negative experiences
  8. Patient apathy

Tools for overcoming barriers

Practice action plan
Use the practice action plan (Tool A) as a means of identifying and working towards overcoming practical barriers to access. The practice action provides the opportunity to discus issues such as clinic hours, childcare facilities in the clinic, transport issues.

Is diabetes testing acceptable?

Focus: Testing is culturally acceptable to your practice population.

Within New Zealand there is wide diversity in the cultural makeup of individual practices, and each practice has its own unique challenges.

Barriers for Māori have previously been identified.8 Common themes include: reduction of cost; increased Māori specific resources and staff, training of health professionals in working with Māori

Questions:

Has the practice considered how it can best manage the needs of the various cultural groups represented in the practice?

Have you established relationship with Maori and Pacific providers who may be able to assist?

Does your PHO have specific programmes and resources you can utilise?

Barriers to providing acceptable diabetes care

  1. Some aspects of the practice may be unacceptable to some groups of people
  2. Lack of cultural competence
  3. Lack of involvement from patients
  4. Methods of communication maybe off putting for some people

Tools for overcoming barriers

The diabetes action plan (tool A) may be a useful way of identifying the unique barriers that face your practice.

Improving cultural competence

The best way for a doctor to learn about Maori is by establishing relationships with the following groups in their locality: Iwi, Maori healthcare professionals, marae and other Maori organisations in their local area.

The Medical Council of New Zealand has responsibility to ensure the cultural competence of doctors. For further reading on cultural competence, see BPJ 13 (www.bpac.org.nz) or New Zealand Medical Council (www.mcnz.org.nz)

Seek community involvement

Ask your patients
The most practical way to determine if the practice is providing an acceptable service, is to ask those who use it - your patients. Try asking patients simple open-ended questions such as “what could we do to make this easier for you?” or “are there any issues that you think are stopping other members of your whanau getting tested for diabetes?”

Engagement in community incentives
In most areas there are resources and services available to increase awareness and to improve the lives of people with diabetes. Being aware of what incentives are available in your area can help you be more responsive to the needs of your practice.

“Lets beat diabetes” (Counties Manakau) and “Ngati and Healthy” (Ngati Porou communities on the East Coast) are two incentives that are targeted directly at the needs of the community.

Peer group review

This resource has focused on examining the system you currently have in place for testing for diabetes, examining barriers and suggesting tools to help to provide a better service. It has focused on asking the questions:

  • Is diabetes testing available, appropriate, accessible and acceptable?

This resource can be considered a starting point. For each practice the barriers may be unique, as well as the solutions but there may also be areas of common ground.

The questions posed in this resource could provide the basis for a peer review group meeting and may provide the opportunity to share solutions, and may be come up with innovative new ideas!

  Peer group review
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