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John Boffa Public Health Medical Officer

Quality improvement in non glycaemic targets in diabetic patients at Central Australian Aboriginal Congress. John Boffa Public Health Medical Officer. Introduction. A historical perspective NPCC and prioritising outcomes Cholesterol control BP control Treatment for renal disease

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John Boffa Public Health Medical Officer

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  1. Quality improvement in non glycaemic targets in diabeticpatients at Central Australian Aboriginal Congress John Boffa Public Health Medical Officer

  2. Introduction • A historical perspective • NPCC and prioritising outcomes • Cholesterol control • BP control • Treatment for renal disease • Brief interventions for SNAP • Eyes and Foot Checks • What has led to the improvements?

  3. 3 historical periods in Diabetes Care in Central Australia Period 1 “Denial” 1988: diabetes but no complications Period 2 “Treatment nihilism” 1994: Scrimgeour and Rowse, Menzies – telling an Aboriginal person they had diabetes was the equivalent of telling a non Aboriginal person they had cancer Period 3 “Hope” 1999: diabetes is preventable and effective treatment from a well resourced PHC sector can make a big difference

  4. Outcomes of improved diabetes management (NPCC)

  5. Cholesterol control

  6. Diabetic cholesterol control

  7. Results: Cholesterol 2006 • Total diabetic population n=541 • Total cholesterol recorded in 75.8% (n=410) • Of those recorded: • 76% Total Cholesterol <5.5 mmol/L • 30% Total Cholesterol ≤4.0 mmol/L • Mean Total Cholesterol 4.7 mmol/L.

  8. Results: Cholesterol 2009 • Total diabetic population n = 734 • Total cholesterol recorded in 79.8% (n=610) • Of those recorded: • 79% Total Cholesterol <5.5 mmol/L • 35% Total Cholesterol ≤4.0 mmol/L • Mean Total Cholesterol 4.5 mmol/L.

  9. Patients on statins have doubled

  10. More active management

  11. Blood Pressure Control

  12. Diabetic Blood Pressure Control <130/80

  13. 2009 BP outcomes • 67% of Diabetic patients (n = 492) have had a BP recorded in the last 6 months • Of these patients, 231 or 47% have a BP < 130/80 • 2006 baseline of about 38% < 130 /80

  14. More BP’s being done

  15. Percentage of patients on medications has increased

  16. Need more active BP management

  17. Renal Disease

  18. ACR / eGFR

  19. More active management

  20. Brief Interventions for smoking and alcohol

  21. Smoking brief interventions

  22. Increased referrals for alcohol

  23. Nutrition and Physical Activity Advice

  24. Eyes, Feet and BMI

  25. Eyes and Feet

  26. BMI

  27. What has led to these improvements? • An evidence based focus on prioritised outcomes and scheduled services • Regular feedback to practitioners about our performance • Improved PIRS functionality: annual cycle of care, recalls, queries, data quality, electronic records • An improved pharmacy system ensuring better access to medications • An improved clinic system ensuring better access to regular GP for chronic disease management with excellent GP retention • Access to a diabetes educator and diabetes nurse • Regular physician clinics

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