National Prevention of Type 2 Diabetes Program Overview

1. National Prevention of Type 2 Diabetes Program Overview Sabrina Ostowari Program Coordinator – Chronic Disease

2. Background to the Prevention of Type 2 Diabetes Program (PT2DP) • Initiative of the Council of Australian Government (COAG) • Part of the National Reform Agenda • $200 million funding allocated for federal and state government strategies to address growth in T2D • Funding allocated to divisions network to focus on 40-49 years and Indigenous adults – PT2DP • Planning and implementation have has begun in all areas

3. Commonwealth Government Commitment • $103.4M to: • Develop an Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) • New Medicare Item number (713) to undertake a type 2 diabetes risk evaluation for 40 – 49y • High risk patients can be referred by GP to subsidised accredited LMP • Develop National LMP Standards for accreditation and a system for accreditation • Funding for the Divisions Network to support delivery of the program at a local level

4. AUSDRISK

5. Aim: Review the factors underlying the 'high risk' score identified by the AUSDRISK to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes Patient Eligibility: 40-49 years of age At “high risk” of diabetes as defined by the AUSDRISK Not likely to have already developed diabetes Has not had an item 717* claimed in the past 3 years MBS Item 713 – Type 2 Diabetes Risk Evaluation *Item 717 (45-49 Year Health Check)

6. Referral to a lifestyle modification program through other Medicare Items • Eligible patients can also be referred through: • Item 717: 45-49year Health Check • Item 710: Aboriginal and Torres Strait Islander Health Check (15-54 years)

7. Relationship Between MBS Items • If a patient has had an Item 717, they can only become eligible for Item 713 when 3 years have elapsed. • A previous item 713 does not preclude an eligible person from accessing item 717 in relation to the risk of developing other chronic illnesses

8. Relationship Between MBS Items • GP cannot conduct an item 713, if a previous 713 has been conducted within the previous 3 years. • If a patient has an item 717, and progresses to high risk of developing diabetes (AUSDRISK) within 3 years, a GP can refer a patient to an LMP through an item #23. For all these reasons, the patients usual GP must provide the risk review.

10. Strong Evidence for Lifestyle Modification Programs (LMP) • Clinical Trials - strong evidence that lifestyle modification can prevent or delay the onset of type 2 diabetes. • RCTs in the US and Finland - reductions in the incidence of type 2 diabetes of 58% over 3 years in people with impaired glucose tolerance • Government has provided funding for patients to attend subsidised accredited LMP

11. National LMP Standards • National LMP standards have been developed - University of Sydney Institute of Obesity, Nutrition and Exercise • Minimum guidelines for the content and delivery of an LMP to reduce risk of type 2 diabetes • Accreditation of LMPs are based on these standards

12. Content of an accredited LMP • Minimum Requirements • Risks of diabetes and the relationship to lifestyle risk factors • Importance of regular diabetes screening • Nutrition advice and education • Physical activity advice • Behavioral strategies to support the adoption and maintenance of lifestyle change • Smoking cessation and alcohol reduction advice if required • Information about community resources relevant to sustaining lifestyle change

13. What will an accredited LMP look like? • Minimum Requirements • Face to face delivery • Individual or group sessions with groups no larger than 15 participants • Minimum of 8 hours of contact time • Initial intensive phase of at least 4 months duration • End program follow up session at least 6 months after commencement of the program (i.e. follow-up session at lease 2 months after completion of intensive phase) • Providers must be able to illustrate their ability to meet core competencies outlined in program standards

14. National LMP Service Directory • Established and managed by AGPN • Hosted on AGPN website (www.agpn.com.au) • As new LMP providers become accredited, AGPN will update the National Service Directory

15. Patient Subsidy • For all eligible patients enrolled in an accredited LMP, the LMP provider will be able to claim a subsidy • The payment will be made as follows: • $77 (inc. GST) on patient enrolment • $121 (inc. GST) on completion of the intensive phase • $37.40 (inc. GST) on program completion • Maximum of $50 patient co-contribution (which is waived for pensioner concession/health care card holders) • GPQ pays the provider the patient subsidy • To receive payment, providers submit the required form with an invoice to GPQ for payment

16. Role of Practice Nurse or other Health Professionals • Identification of eligible patients • Undertake components of the diabetes risk review or health assessment e.g. AUSDRISK tool, clinical measures • Provide detailed information about the benefits and components of the lifestyle modification program • Provide patients with information and resources to support lifestyle modification

17. PT2DP – State Update • Referrals to LMPs • 43 eligible referrals received at GPQ from across 8 divisions • Most referrals through 713 • Accreditation of LMPs in QLD • Reset Your Life, Re-Energize (MBGPN), Health Wise Choice (Private Organisation – services provided in NWQPHC and TGPN), Act Now (Private Organisation - services provided in General Practice Cairns) • LMPs have commenced in CQRDGP, TGPN, BSDGP, SEAGP, MDGP • Courses commencing soon: IWMDGP, SCDGP

18. State Strategies to Support the Program • Steering Committee Established • Marketing and Communication Resources • Quarterly Teleconferences • Operational Listerves (Divisions and LMP Providers) • Weekly information in Chronic Disease Update • Question and Answer Register (disseminated weekly) • Division visits • Ongoing Liaison and Communication with LMP Providers • Ongoing Maintenance of Centralised LMP Payment System and Data Entry • Workshops • Supporting accreditation of LMPs in QLD • Coordinated and funded Reset your life facilitator training • Partnerships with key stakeholders (e.g. DAQ, QH, ECCQ)

19. Questions?

20. Thank you