A pilot diabetes control project which relies on a computer link between GPs and hospitals is helping curb the disease in hard-hit south Auckland.
The project, which led to a reduced incidence of severe cases of the disease, has been extended from one GP practice to 17. It has seen the proportion of patients with an of HbA1c reading — a measure of the seriousness of diabetes — of nine or more reduced from 34% to 7% over three months at the pilot practice in Mangere.
“Diabetes has been described as an epidemic and it’s particularly bad in the Counties-Manukau DHB area, because of socio-economic and lifestyle reasons,” says Counties-Manukau and Waitemata DHB CIO Phil Brimacombe.
“Too many people with diabetes progress unnecessarily to the advanced stages of the disease and it’s a disease that’s easy to spot and treat early.”
The basis of the pilot and expansion is an “integrated care server”, at the heart of a network linking the GP practices.
“The DHB funds GPs to enrol diabetes patients in the programme, the GP captures the data set on a template and the patient management system sends it to the integrated care server.
“The server applies a rules engine, the same rules a doctor would apply when assessing a diabetes patient and sends the data back to the GP.”
Brimacombe says the data provides clinical decision support, but the GP makes actual decisions on the patient’s treatment.
The integrated care server is linked to Middlemore Hospital’s emergency patient tracking system, meaning doctors at the emergency department will be alerted if a diabetes patient is admitted to the department.
“With one mouse click the emergency doctor can see if the patient is a diabetic and get other medical information.”
The success of the diabetes tracking system has led to it being applied to other conditions including heart disease and congestive heart failure and there are plans to roll out tracking for those across the Counties-Manukau, Waitemata and Auckland DHB coverage areas in the future, Brimacombe says.
Brimacombe, speaking at a New Zealand Computer Society event last week, also told of how an integrated care server, applied to immunisation tracking, had achieved success in Otara, raising rates for the immunisations tracked in that suburb from 45% to 90%.
“It involved getting an electronic patient record for every child enrolled in the programme and if the system isn’t told that about an immunisation that’s due, it gives a message that it’s overdue.”
The scheme, called WellChild, is running in Otara, Franklin, Papakura and the Waitakere region of the Waitemata DHB and there are plans to extend it fully across both DHBs, Brimacombe says.
WellChild is the model for a national immunisation programme planned by the Health Ministry, he says.
“The stage one prototype has been completed, stage two is being worked on and the system should go live by the end of the year.”