Diabetes Clinic Management

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Diabetes Clinic Management

• Terry Rose
• www.opsun.com.au

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Introduction

• Aberfoyle Park Medical Centre
• Southern Suburbs of Adelaide, S.A.

• We had a baby boom in the 80s and 90s
• More recently older couples have moved here to
  retire

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Some of the team

• 5 doctors (3FTE)
• 1 practice nurse (0.1 FTE)
• 4 admin staff
• NPCC wave 3

• The team has embraced the NPCC change principles

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Special Interests

• Making computer based clinical information
  more easily accessible has been an abiding
  passion for me for over ten years. My aim is to
  move the computer into the background so that I
  can focus more on face-to-face consulting.

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Challenges of General Practice

• Compliance with enhanced primary care initiatives
  - e.g. 12 parameters of a diabetes annual cycle
  of care - are the criteria met?
• Creating clinics and targeting high risk groups

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What do we do?

• 4 appointments/hour
• Extensive use of MD Shortcuts and templates
• A lot of 717s and even G.P.M.P.s are completed
  opportunistically
• Clinic Manager - purpose built

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Three take away points

• Use shortcuts and templates
• Instant results
• 49 year olds

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Type diab in the progress notes
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Text created by the shortcut diab
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Type cdm in the progress notes
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Text created by the shortcut cdm
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The management plan template has several user
defined fields
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Management Plan - 20/01/2007 Mr. R. E. Aberfoyle
Park SA 5159 Review Date 20/7/2006 Copies
to Dr Champion and Wade Hampton -
Podiatrist List of problems and their
management Current Medications DIABETES
GOAL ONE - Maintain glycosylated
haemoglobin less than 7. This is a measure of
how sugar is affecting. etc etc etc MANAGEMENT
STEP - Six monthly blood test for
HbA1c PERSON RESPONSIBLE R. E. and Dr. Terry
Rose DIET AND EXERCISE There is considerable
scope for lifestyle modification including We
recommend at least 3 hours a week brisk
walking We recommend a low fat, high fibre diet
with at least 2 litres of water per
day PREVENTIVE HEALTH We recommend a yearly
fluvax and a pneumonia vax every 5 years.
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Three take away points

• Use shortcuts and templates
• Instant results managing the individual patient
• 49 year olds

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Welcome to our programme
The wombat is one of South Australias animal
emblems and was originally suggested as a name
for the programme
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Print latest results for one patient
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Mr. R. E.These measures are used to help you
better manage your diabetes. Wednesday, 17
January 2007

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Serial results for Mr R.E.
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Three take away points

• Use shortcuts and templates
• Instant results managing several patients at
  once
• 49 year olds

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Return rates on mail-outs

• Diabetes clinic mail out inviting patients to
  attend 5 return rate
• Free 45 to 49 health checks (717) 10 return
  rate
• Latest targeted mail out over 50 return rate

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How do we do a mail-out?

• Choose our target group - e.g. last HbA1c over 6
  months ago, or HbA1c over 10
• Enclose latest results with targets and reasons
  for targets
• Path request form - Hba1c, cholesterol,
  microalbumin
• A letter specifically asking patients to get the
  test done and see us a week after
• Personally signed

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Choose our target group
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This is our mail-out
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Diabetic patients last date doctor seen
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Diabetic patients last date doctor seen
 
 
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Ideas for using the Past History section of MD

• We record all these item numbers in the Past
  History section of MD
• 717 - once only 45 to 49 health check
• 721 725 - management plans
• 2517 etc - cycles of care
• 2710 2712 - mental health plans

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Finding items in the Past History of MD
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Finding Cycles of care
 
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Finding uncoded diabetes
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Three take away points

• Use shortcuts and templates
• Instant results
• 49 year olds

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Type 717 in the progress notes
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Text created by the shortcut 717
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Use Clinic Manager to identify at risk 45 to 49
year olds
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List of 49 to 45 year olds
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45 to 49 year olds

• Send an invitation to the 49 year olds first -
  before they turn 50!
• We flag 45 to 49 year olds in the appointments
  programme

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Challenges and opportunities

• One doctor in our Practice finds all these new
  item numbers very challenging
• We are now targeting subgroups of patients such
  as infrequent attenders and patients whose
  diabetes is poorly controlled, and recalling them
  as a group
• We are developing practice-wide protocols for the
  treatment of osteoporosis, COAD and chronic renal
  failure

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Visit www.opsun.com.au to download the programme
or the templates click on npcc page
Where to now?
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Thank you
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If you want to see more than the 3 basic
parameters