I was interested to get bpac report re. diabetes testing. Many of my diabetic patients are enrolled in a chronic care
management scheme with the Counties Manukau DHB. They have minimal requirements for lab testing � these include;
These criteria (amongst many others) need to be met if we are to receive payment for managing these patients. If you
think these tests are too frequent, I suggest you contact the DHB rather than the GP�s who are obliged to order them.
Dr Gary Sinclair (Clinical Director Primary Care and Chronic Care Management, Counties Manukau DHB) responds...
The Diabetes CCM programme was initially developed in 2001 based on an expanded version of the Chronic Care Model
developed by Ed Wagner, using a Kaiser approach to delivery of service. As part of the delivery system redesign, information
systems and decision support, CMDHB developed �templates� in locally used patient management systems for collection
of the disease specific dataset for communication to a central �integrated care� server which collects data for decision
support, exception reporting and general programme management.
At that time the national guidelines for diabetes and cardiovascular disease were in development, and so the clinical
dataset (including required laboratory investigations) was derived on advice from a local programme disease specific
advisory group (DSAG) which included physicians from both primary and secondary care in CMDHB.
Given that the CCM programme is targeted at high acuity patients (all patients have to satisfy entry criteria
demonstrating poor control of clinical management indicators or signs of advanced end organ damage), and to facilitate
ease of programme implementation, the DSAG advised on regular three monthly testing for HbA1c, serum creatinine and
albumin-creatinine ratio, lipids being tested every six months.
With the release of national guidelines for the management of diabetes and cardiovascular disease, we noted some
variance between guideline based �best practice� and the CCM programme requirements for some of our enrolled patients.
We are currently engaged in the process of integrating the CCM programmes for diabetes and cardiovascular disease,
based on the current national guidelines and incorporating requirements for the �Get Checked 2� dataset. At this stage
we anticipate migrating to the new platform early in 2008. The new programme will have the IT capability to advise
on different management for different individuals (including laboratory investigations) based on individual patient
The DSAG has discussed the present laboratory testing protocols, and support the best practice guidelines articulated
by bpacnz. However in the interests of maintaining programme integrity, DSAG have advised that we continue
collecting lab data at the afore mentioned intervals relying on the judgement of our clinicians regarding actual testing
intervals until the decision support platform is deployed.