A partnership approach to prevention of Type 2 Diabetes at the Central Coast Division of General Practice 

The Central Coast region is situated approximately 90km north of Sydney and covers an area of 1853km2.  It has a total population of 297,957 (2006 Census) with 93 General Practices and 294 GPs. There is a greater proportion of younger people than the general population, and a significantly smaller population over the age of 44 compared to the general population.

The Division supports a range of Lifestyle modification programs, and has had some early success in attracting appropriate referrals. The Division is about to complete the first of its Reset for Life Programs with 15 people attending, and has two more LMP programs ready to start under the Commonwealth funded Prevention of Type Two Diabetes Program. One of these programs will be run through the local Aboriginal Medical Service – Eleanor Duncan.

How have they achieved such a high rate of referrals?

Development of relationships between Exercise Physiologists and GPs.
In 2008, the Division received funding from DoHA under the Australian Better Health Initiative Schools and Communities Grant to increase physical activity participation in the local community, recognising this as a changeable risk factor for chronic disease. The Division appointed a Lifestyle Officer to improve the relationship and referral rates between General Practitioners and Exercise Physiologists. The Division undertook a number of activities to raise the profile of Exercise Physiologists including:

• Developing and disseminating a resource directory of local Accredited Exercise Physiologists. The directory included their areas of expertise, hours of work and cost for private consultations.
• Inviting Exercise Physiologists to join in the Divisions existing General Practice education sessions.
• Using local Exercise Physiologists to present at these meetings on relevant areas of expertise – including the benefits to patients from increased exercise
  

Through this process of engagement, closer working relationships have been developed between General Practice Teams and Exercise Physiologists. The Division regards this ground work as a critical success factor for the success in up take for their range of lifestyle modification programs and for the increase in the claiming rates for of Allied Health Professionals using Medicare Item numbers.

Case Finding in GP Practices

Two of the local Exercise Physiologists provide services and consultations within eight General practice teams. The Practices provide the Exercise Physiologists with free use of facilities and in return the Exercise Physiologists use their time between booked consultations to offer free administration of the AUSDRisk tool to patients waiting to see the GP or Practice Nurse. Through these screening tests and opportunistic conversations about prevention and physical activity, the Exercise Physiologists have identified eligible patients to be referred to the local LMP program. In addition they have identified many more patients with undiagnosed diabetes, and still others with chronic diseases who could benefit from health assessments and/or team care arrangements.

Communication with the General Practice team – a critical success factor!

The Exercise Physiologists use a simple check list to suggest to the GP which services the patient may benefit from and even book the patient in with the practice nurse and GP to start the process of the GP Management Plan or Team Care Arrangement. In addition to a referral to the Lifestyle Modification Program the Exercise Physiologists offer individual consultations through the EPC items or private health funds and Diabetes group programs for patients with diagnosed Type 2 Diabetes.

The lifestyle officer at the Division commented “the GPs love it – because the Exercise Physiologists based in the practice are finding patients who are appropriate for health checks, team care arrangements and groups. The Practice loves it because the Exercise Physiologists don’t create extra work for them but work in with their systems. The Exercise Physiologists love it because they are using time when they don’t have booked appointments to identify potential patients they can work with and help people to make significant changes in their lives”  Dr Phil Godden (Chair Central Coast Division of General Practice) also commented “any initiative to support the community and the GPs in management and prevention of the onset of Type 2 Diabetes is a positive step”.

For more information about this project please contact Lyndell Crawford Round lyndellc@ccdgp.com.au or Melissa Wilkinson melissa@ccdgp.com.au  or phone 02 4365 2294.