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A Cycling Tour of Diabetes Karen Booth RN Leichhardt General Practice
Be Prepared! Are We in the Zone? How Will We Get There? The Strategic Plan!• What do you want to achieve? Target audience• Marketing (letter, phone, opportunistic, dr refer)• Space & Time / Appt schedule e.g. nurse then doctor• Budget e.g. cost of staff & room
• Equipment, documents/templates• Division of labor/ teamwork/roles• PIP & SIP incentives• How do you bill??• Recalls & flow on services (referrals, HMR, care plan)• ***Establish a Model/Process that could be Easily Replicated***
Help Them Keep TheirBalance• Annual cycle of care• 6 month review• 10997 for CDM monitoring visits with the nurse• GPMP & TCA• Referral pathways for support (allied, Type II programs etc)• Build in the expectation of the return visits
Remove the Training Wheels! Get Out on the Velodrome!• Give them information• Feel empowered to take control of their own health• Respond well to recalls, most pts are attending scheduled visits• Monitoring own BSL & weight• Regular exercise program
Puncture Repair• Regular review for maintenance & treatment adjustments• May need new referrals• Endocrinologist, Clinic review• Diabetes educator, exercise phys referrals• Motivation
THE LEICHHARDT GENERAL PRACTICE DIABETES MANAGMENT CHECKLIST Activity Target Frequency Date Date Date Date Date Values Hb A1c < 7.0% 6mths u/a Microalb < 20mg/L 12mths spot catch Cholesterol < 4.0 12mths Triglycerides < 1.5 12mths HDL > 1.0 12 mths LDL < 2.5 12 mths Weight 6 mths Height 12mths BMI 25 6 mths BP <130/80 6 mthsExamine feet 6 mths Eye check 2 yr min Selfcare 3-6 mths Diet review 6 mths Physical activity 6 mthsSmoking status 6 mths Medication 6 mths review EC G 12 mths
Cycling is a Team Sport• Coach – GP• P/T, Mx - Practice Nurse• Support Crew – Clerical staff• Specialist support – Endocrinologist, Diab Educ, Dietitian, Exercise Phys.
New Patient: Joan• A 66 year old female type II diabetic, Joan, has recently moved to your area to be nearer to her family. She would like to renew her prescriptions.• The receptionist books her 1st visit as a long consult
• Triage by nurse: records BP, Wt, past medical history, medications & supplements?, vaccination status etc.• She has her current tablet packets with her.• She states she has been very happy with her current medication & would just like some repeats please!• Pt has been diabetic for past 9 Yrs• Has been taking tablets past 2 years• Discovered high BSL when having routine cholesterol check (which was also “a bit high” but pt has switched to low fat milk)• Moderately obese, BMI 30, BP 140/85, P 90 reg• (Hx diabetes & High cholesterol past 9 yrs) Mild hypertension not previously noted
• Patient does not take own BSL• Joan likes to get her prescriptions with all her repeats “filled” at the same time. This saves her having to go back to the doctor or the chemist unless she feels unwell.• Patient does not have set exercise regime because she does enough running around when she visits the grandchildren & doing the housework.