Better health and ageing for all Australians

Historical publications

Highlights of Government Support for Diabetes 1999 - National Focus for Government Action

This report is designed to inform non-government organisations, service providers and health professionals of the broad range of diabetes initiatives funded by Commonwealth and State and Territory governments.

In this section:

Highlights of Government Support for Diabetes 1999
The report aims to inform those in service planning and provider roles of the types of activities being funded by Commonwealth and State/Territory governments.

>> Forward
>> Introduction
>> What is diabetes?
>> National focus
>> Management of specific complications
>> Groups with special needs
>> The way forward
>> Contacts

National Focus for Government Action


National action on diabetes can be described in terms of four areas:
  1. action which is targeted across the continuum of care;
  2. action targeted at the primary prevention of diabetes;
  3. action targeted at detecting diabetes as early as possible;
  4. action targeted at improving the care of people with diabetes.

Top of page

Highlights of Government Action

Commonwealth Action

Each year the Commonwealth undertakes extensive activity in relation to specific diabetes initiatives including research, pharmaceutical benefits, general practice and public health.

Commonwealth Diabetes Taskforce

The Commonwealth Diabetes Taskforce has been appointed to provide the Commonwealth Minister for Health and Aged Care with high-level, independent advice on diabetes, as well as providing strategic direction for the implementation of the National Diabetes Strategy. As a body of experts, it has provided advice on the development of the Strategy.

Research

Forty-four researcher-initiated research projects and scholarships in diabetes or diabetes-related areas have been funded through the National Health and Medical Research Committee (NHMRC). A joint venture to support research into insulin-dependent diabetes in Australia has been agreed between NHMRC and the Juvenile Diabetes Foundation of Australia.

National Diabetic Services Scheme (NDSS)

People with diabetes may register with the NDSS to obtain access to subsidised syringes and diagnostic agents such as blood glucose test strips. The NDSS is administered under contract to the Department by Diabetes Australia and products are available through Diabetes Australia sub-agents and mail order. In 1997-98, the Government spent about $37 million on subsidising the cost of syringes and diagnostic agents to people with diabetes through the NDSS.

Pharmaceutical Benefits Scheme (PBS)

The PBS aims to provide timely, reliable and affordable access for the Australian community to necessary and cost-effective medicines. People with diabetes may access insulins and other drugs necessary for the management of their condition through the PBS as well as diagnostic agents. PBS benefits are available only on prescription. In 1997-98 the Government spent about $106 million on anti-diabetic medications and diagnostic agents through the PBS.

Top of page

General Practice

A series of coordinated care trials has begun to test different models of service delivery and funding arrangements. The SA Health Plus trial focuses specifically on the multiple medical needs or conditions that derive from respiratory, diabetes and cardiac complications. It is anticipated that results from the National Evaluation of trials will be available in 2000.

The National Divisions Diabetes Program is an initiative of the Integration Support and Evaluation Resource Unit of the University of New South Wales funded by the General Practice Branch of the Commonwealth Department of Health and Aged Care. The Program is a coordinated approach to diabetes care in general practice aiming to facilitate "best practice" diabetes care through general practitioners and Divisions of General Practice working in collaboration with diabetes care providers and organisations.

Public Health

Several national health strategies have or are developing effective approaches to specific health issues through a partnership approach. The Commonwealth is developing a National Diabetes Strategy in partnership with State and Territory governments, non-government bodies and health professional associations.

In 1996-97 the Commonwealth also provided $7.7 million over three years for the development and implementation of a National Diabetes Strategy. These funds have been further increased with an annual amount of $2 million being made available from the 1999-2000 financial year. Activities supported through funds are described throughout this document and include:

  • a diabetes vision-impairment prevention program;
  • the development and distribution of evidence-based guidelines including NHMRC retinopathy guidelines disseminated in 1998;
  • the establishment of a National Diabetes Register administered by the Australian Institute of Health and Welfare;
  • activities for Aboriginal and Torres Strait Islander people administered by the Office for Aboriginal and Torres Strait Islander Health (OATSIH) and including a diabetes coordinator appointed by the National Aboriginal Community Controlled Health Organisation (NACCHO);
  • a Community Awareness of Diabetes Strategy being developed by Diabetes Australia; and
  • a diabetes prevalence study (AUSDIAB) being conducted by the International Diabetes Institute.

Top of page

Action Across a Continuum of Care

As a chronic condition, diabetes requires action across the continuum of care - prevention, acute treatment and long-term management.

This has been recognised in all jurisdictions in Australia, as evidenced by the establishment of collaborative planning mechanisms in all States and Territories.

These 'diabetes taskforces' involve key service providers including general practitioners, hospital and community-based providers, non-government providers and consumers.

They aim to coordinate diabetes service delivery and guide policy development.

This collaborative action on diabetes is leading the way for similar collaboration on other chronic diseases.

State-based Approach

Australian Capital Territory

ACT Integrated Diabetes Disease Management System:
The ACT Government has recently adopted an integrated diabetes management plan for the ACT region following an extensive review of services delivery. The integrated diabetes care system will be implemented during 1999 with the establishment of an overarching ACT Diabetes Council. The Council will be the peak advisory body to the Territory Government on emerging and current issues. Four key program areas - Diabetes Health Promotion and Community Awareness programs, Primary Care service, Tertiary Care service, and Population Health Outcomes and Effectiveness Monitoring - are supported in the management framework. The framework proposed uses the complexity of individual care needs and the location of care delivery to distinguish between levels of service. The commitment to the integration of diabetes services has enabled the creation of a multidisciplinary diabetes team providing more equitable access to services for consumers.

Contact: Myree Rawsthorne, Health Policy Unit, ACT Department of Health and Community Care. Ph   (02)   6205   0929 or e-mail myree_rawsthorne@dpa.act.gov.au

Top of page

New South Wales

Diabetes Expert Panel:
There is considerable evidence and consensus that the outcomes of diabetes care can be improved if people with diabetes have better access to quality diabetes services including: information and self-care education; ongoing routine care aimed at achieving and maintaining good metabolic control; and regular screening for the early detection and appropriate treatment of complications.

Formal collaboration on the measurement of diabetes outcomes between the NSW Health Department and clinicians from medical, nursing and allied health backgrounds, and consumers is occurring. This collaboration has resulted in the identification of process and outcome indicators for diabetes care, and the development of a system to make clinical indicator information available in different health care settings. A major outcome of this collaboration has been the identification of evidence and consensus-based Clinical Management Guidelines for Diabetes to guide clinical decision-making and provide criteria against which the processes of clinical care can be assessed.

Implementing evidence and consensus-based standards of diabetes care into clinical practice has also been a focus of the Expert Panel. The outcomes for people with diabetes can be substantially improved by providing better access to quality diabetes services and supporting primary health care strategies such as the Aboriginal fruit and vegetable cooperative. Effective models of ambulatory and shared care are already being practiced in some centres in metropolitan NSW, providing exemplars of comprehensive clinical and patient education services.

Contact: A/Professor Steven Boyages, Centre for Research and Clinical policy. Ph   (02)   9391   9191.

Diabetes Integrated Care Pilot Project:
The Diabetes Integrated Care Pilot Project sites are in Western Sydney, the Mid North Coast and the Far West. Each pilot project involves the local Division of General Practice, Aboriginal Medical Service, Diabetes Centre and other specialist diabetes health care providers; and people with diabetes, who have agreed to participate in the pilot project. As well as the experience and knowledge gained about the levers and barriers to integrating care for people with diabetes, tools were developed to measure the process and outcomes of this model of integrated care. These are: a checklist for auditing clinical records of patients; a patient health and satisfaction questionnaire for people with diabetes; a set of criteria for assigning people with diabetes to a stage in the natural progression of the disease; a diabetes-specific database for measuring the outcomes of diabetes care and for monitoring patient status, and for recalling patient for follow-up care; a method for costing inpatient care for people with diabetes; and a questionnaire for assessing the level of integration of diabetes care.

Contact: Jeanette Sheridan, Centre for Research and Clinical policy. Ph   (02)   9391   9944.

Top of page

Northern Territory

NT Coordinated Care Trials:
Territory Health Services (THS) is sponsoring the implementation of two national Commonwealth-funded Coordinated Care Trials in conjunction with an Area Health Board representing each of the two remote trial areas - Katherine West and the Tiwi Islands. The NT Trials aim to improve population and individual health and well-being through a combination of community control of health funding and policy-level decision making and improved delivery of care. The Tiwi Coordinated Care Trial began its live phase on 4 December 1997 and the Katherine West Trial began in July 1998. Both trials are subject to external evaluation and will run to 31 December 1999. The key aspects of the trials are:
  • community control of the purchasing of health services through fund-holding Area Health Boards, representative of the predominantly Aboriginal trial populations;
  • flexible funding arrangements as well as an increase in available funding through improved access to Medicare and Pharmaceutical Benefits Schemes and coordination of NT and Commonwealth funding; and
  • care coordination - improved management of chronic illness and population health care through more efficient and better coordinated primary prevention, detection and intervention.

A suite of Standard Care Plans, which includes Diabetes and Gestational Diabetes Care Plans, has been developed by the Guidelines, Standards and Audit Team (GSAT). Standard Care Plans comprise a part of the new health centre-based information system and can be individualised for clients by their health worker, nurse or medical practitioner. Population Care Plans also address prevention and early detection of diabetes and other chronic illnesses.

Contact: Jenny Cleary. Ph   (08)   8922   7083 or e-mail jenny.cleary@nt.gov.au

NT Preventable Chronic Diseases Strategy (PCDS):
This long-term strategy addresses diabetes as one of a group of linked chronic diseases (together with high blood pressure, renal disease, ischaemic heart disease and chronic airways disease) since these diseases have common factors directly underlying them, most notably poor nutrition, inadequate environmental health, alcohol misuse and tobacco smoking. The PCDS sees the diseases and their underlying factors as potentially preventable, but improvements in early detection and disease management approaches are also planned. A range of comprehensive care plans has been developed for the chronic diseases (see NT Coordinated Care Trials) which include family and community roles to complement individual self care; the establishment of early detection protocols and support services; and a roll-out of recall systems to communities not covered by the Coordinated Care Trials. The PCDS addresses the whole of the NT population, whereas the NT Coordinated Care Trials are focused on the Aboriginal population of the NT.

CONTACT: Tarun Weeramanthri. Ph   (08)   8922   8513 or e-mail tarun.weeramanthri@nt.gov.au

Top of page

Queensland

Queensland Expert Advisory Group on Diabetes:
During 1997-1998, an expert advisory group was convened to develop a five-year Statewide Health Outcomes Plan for diabetes. Issues being examined include the outcomes to be achieved for diabetes, the indicators to monitor progress towards these outcomes and required data systems. The plan will recommend evidence-based strategies to guide service purchasing in addition to models of care for type 1 diabetes among young people and for type 2 diabetes among adults. The development of this Health Outcomes Plan represents the first concentrated effort on diabetes planning across prevention, treatment and management and involved experts from public health, health promotion, general practice, endocrinology, ophthalmology, obstetrics and allied health. Diabetes Australia (Qld), the Australian Kidney Foundation and the National Heart Foundation have also been involved in its development. The Health Outcomes Plan process has instigated the development of an Indigenous Chronic Disease Strategy that will be progressed in 1999.

Contact: Ellen Hawes, Health Outcomes Unit, Qld Health. Ph   (07)   3234   1774 or e-mail hawese@health.qld.gov.au

Improved Queensland Nutrition Infrastructure:
A Statewide nutrition coordinator is being appointed in Queensland to be supported by three whole-of-community nutritionists across the Southern, Central and Northern zones. These positions will facilitate the local implementation of Statewide nutrition strategies and focus across the continuum of care (ie improving the nutritional status of the whole community which includes primary, secondary and tertiary prevention activities).

Contact: Michael Tilse, Manager Health Promotion Services, Qld Health. Ph   (07)   3234   0622.

South Australia

South Australian Goals and Targets for Diabetes:
In June 1997, the South Australian Government endorsed diabetes as one of six State Health Priority Areas. A set of goals and targets for reducing diabetes prevalence and improving health outcomes for people with diabetes was developed. In addition, the SA Government endorsed the establishment of a Diabetes Health Priority Advisory Group and a SA Diabetes Clearing House. These will assist in the development of strategies to achieve the State goals and targets for diabetes.

Contact: Tony Woollacott. Ph   (08)   8226   6033 or e-mail Tony.Woollacott@dhs.sa.gov.au

South Australia's Diabetes Health Priority Area Advisory Group:
This group was developed in 1997 to provide advice to the SA Health Commission, now the Department of Human Services. Group representatives include medical specialists, allied health professionals, nurses, general practitioners, consumers and policy makers. Its role and function includes providing advice regarding diabetes as a health priority area in developing and implementing strategies to achieve set targets; setting targets where appropriate; reviewing targets taking into account trends; improving health outcomes for people with diabetes and advising how to best contribute and respond to developments. The group has worked in partnership with the Department of Human Services to develop a draft Strategic Plan for Diabetes in SA.

Contact: Chair Dr Phil Popplewell, Flinders Medical Centre. Ph   (08)   8204   5511.

Strategic Plan for Diabetes in South Australia:
The plan builds on and formalises the strengths of the current system and identifies new directions for the next five years. The plan identifies opportunities to optimise working relationships between funders, providers and the community to maximise health outcomes for people with diabetes. Strategies are identified as mechanisms for implementing changes that will help reduce the prevalence of diabetes and its impact on the health of people who have diabetes. Widespread consultation was held with key stakeholders and agencies in the area of diabetes to develop the plan. It was finalised in March 1999.

Contact: Alison Pascoe, Strategy and Operations, Department of Human Services. Ph   (08)   8226   0759.

South Australian Diabetes Clearing House:
The Clearing House has been established under the auspice of the Diabetes Health Priority Area Advisory Group and is based in the Department of Human Services. It provides information about diabetes, and those who experience it, in order to better direct policy and program development. As well as reviewing, analysing, evaluating and summarising available information about diabetes and current approaches to intervention, the Clearing House will establish a research program. Where gaps in knowledge about diabetes are identified, research will be conducted to gain further knowledge and improve the information that guides the SA Health Goals and Targets for diabetes.

Contact: Jacci Parsons, Coordinator, Diabetes Clearing House, Department of Human Services. Ph   (08)   8226   0739.

Top of page

Tasmania

Diabetes Policy and Program Manager:
In 1998, the first Diabetes Policy and Program Manager was appointed to develop a Statewide strategy for a coordinated and consistent approach to policy planning and service development in diabetes and to provide input into national diabetes policy. A multidisciplinary group of key health professionals involved in diabetes service delivery provides professional advice and strategic direction on diabetes policy and planning.

Contact: Liz Bingham, Diabetes Policy and Program Manager, Health Advancement, Department of Health and Human Services. Ph   (03)   6233   6117 or e-mail liz.bingham@dchs.tas.gov.au

Menzies Centre for Population Health Research:
The Menzies Centre maintains its basic operations through the support of the University of Tasmania, the State and Federal Governments and the Menzies Foundation. Some funding is also provided by other government bodies, research grants and commercial contractual agreements. Since its inception in 1988, the Menzies Centre has developed a strong reputation as one of the world's leading research institutes specialising in epidemiology and public health. The Menzies Centre works in collaboration with the International Diabetes Institute in Melbourne. As a World Health Organisation research body for the primary prevention of cardiovascular disease, the centre has entered a partnership with the Commonwealth Department of Health and Aged Care to establish and develop the Burnie Take Heart Project in North-West Tasmania.
Tasmanian Insulin Treated Diabetes Register:
The Tasmanian registry was established in 1984 to look into the cause, treatment and prevention of diabetes and its complications. The registry seeks information on all cases of insulin-treated diabetes in Tasmania and is unique in Australia. Most registries worldwide collect information on people developing diabetes in childhood only. The Tasmanian registry seeks to collect information from people who begin insulin at any age and is one of only two registries in the southern hemisphere to do so. This may help determine why some people develop diabetes requiring insulin in childhood while others do not develop it until adult life.
GADA Study:
This study aims to obtain population-based data on the blood level of glutamic acid decarboxylase antibodies (GADA) in people with insulin-treated diabetes mellitus. Several hundred volunteers from the registry and their relatives are helping to develop this test by donating a blood sample. The data collected is being used to confirm how well the GADA test distinguishes between type 1 and type 2 diabetes. The GADA test can also be used to predict type 1 diabetes before clinical onset.
Genetic studies of diabetes:
Tasmania offers a well-characterised, self-contained and stable population over six to seven generations, providing a unique opportunity to investigate the role of genetic factors in chronic disease states such as diabetes. This study, which began in late 1998, will collect information from Tasmanian families with non-insulin dependent diabetes. Family history, demographics and other relevant information will be obtained by interview and blood samples will be collected for genetic analysis.

Contact: Professor Terry Dwyer. Ph   (03)   6226   7700 or e-mail T.Dwyer@utas.edu.au

Tasmanian Divisions of General Practice:
The three Divisions of General Practice in Tasmania - North, North-west and South - have diabetes programs which comprise screening components, recall registers, GP education and multidisciplinary shared-care diabetes management programs in collaboration with the State Government and Diabetes Australia. Although each Division is conducting diabetes programs designed to meet local needs, there are plans to collate data towards improving and coordinating case finding and diabetes management Statewide.

Contact: Dr Geoff Chapman. Ph   (03)   6278   9772 or e-mailsouthtas@gpnetwork.net.au

Top of page

Victoria

Victorian Diabetes Taskforce:
The taskforce comprises key stakeholders in Victoria to make recommendations regarding delivery of effective, efficient and appropriate diabetes services and to provide advice to enable strategic positioning of the Victorian Health System to support the National Diabetes Strategy. The taskforce is supported by DHS and Diabetes Australia and reports to the Minister for Health. The Victorian Diabetes Taskforce has developed its Action Plan 1998/1999 in which it identifies key areas for action, including: shared care, health service planning, gestational diabetes mellitus, and foot and eye complications.

Contact: Kay Mills, Public Health and Development Division, DHS. Ph   (03)   9637   4026 or e-mail kay.mills@dhs.vic.gov.au
Top of page

Western Australia

Western Australia Diabetes Services Taskforce
A multidisciplinary taskforce has been formed by the Health Department of WA. Members include GP Divisions/RACGP and rural GPs, nurse educators, allied health, Aboriginal Medical Services, consumer groups and Health Department representatives. The priorities are to develop a State Diabetes Strategic Framework to guide diabetes planning and service development, and to provide input into national diabetes policy.

Contact: Clare Chamberlain, Purchasing Unit, Health Department of WA. Ph   (08)   9222   2194 or e-mail Clare.Chamberlain@health.wa.gov.au

Graduate Diploma in Advanced Practice (Diabetes Education):
This post-graduate course, offered through Curtin University, addresses the ADEA competencies and new curriculum guidelines. The course will be one year full-time or two years part-time, offered as distance education. Once one-year full-time or equivalent clinical experience is gained, it can be used as the basis for attaining credentialling as a diabetes educator.

Contact: Maureen Unsworth, Eastern Perth Public and Community Health Unit. Ph   (08)   9224   1661 or e-mail Maureen.Unsworth@rph.health.wa.gov.au