DOR Report_2010 - Diabetes Outreach

Diabetes Outreach
Service Report
2010
Jane Giles
Manager

Diabetes Outreach Report 2010
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Contents
page
1. Acknowledgements 5
2. Executive Summary 6
> Highlights of 2010 6
> Proposed 2011 priorities 7
3. Background 10
4. Diabetes Outreach in 2010 12
4.1 Whole-of-population approach 12
4.2 Standards of care 12
4.3 Training and support 13
4.4 Professional and consumer resources 16
4.5 Network collaboration 17
4.6 Quality assurance and documentation 18
4.7 Professional activities 18
5. Attachments 19
6. References 44
ISSN: 1834-9943
Printed January 2011
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Diabetes Outreach Report 2010
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Acknowledgements
Diabetes Outreach acknowledges the significant contribution made by Country Health SA rural and remote
health care providers to diabetes education and care.
Diabetes Outreach would also like to acknowledge and thank:
> Aboriginal Health Council for their support and guidance in progressing Aboriginal Health Worker
training and support.
> Country Health SA – SA Health for their support and leadership.
> The Queen Elizabeth Hospital, Lyell McEwin Hospital, Royal Adelaide Hospital, Flinders Medical
Centre, Repatriation General Hospital and Modbury Hospital Diabetes Centres and Endocrine
Services for their contribution to the development of education resources, education programs and
support for rural and remote health care providers.
> General Practice SA (GPSA) and individual Divisions of General Practice for their partnership,
contribution and support.
> University of South Australia, Department of Health Science, Nursing and Podiatry Schools and
the Flexible Learning Centre for their partnership, contribution and support in the development of
resources and education programs.
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Executive Summary
Diabetes Outreach is a Country Health SA (CHSA), SA Health program that provides initial and continuing
professional education and support for health care providers in rural and remote South Australia. In 2010,
Diabetes Outreach continued to implement the outcomes of the 2009 Country Health SA survey of Diabetes
Outreach users with the aim of continuing to build local capacity and service integration.
Through its clinical leadership, education programs and models for clinical support, Diabetes Outreach
continues to focus on building the capacity of all country health services to offer a safe and basic level of
diabetes information, education and care. In addition the general hospitals and larger community hospitals
as identified by Country Health SA offer a more specialist level of education and care. Shared care options
are supported to facilitate the best care as close as possible to where the person lives. A seamless patient
journey is integral to this model.
The report highlights the key outcomes for 2010 and proposed activities in 2011. These activities aim to
support access for all people with all types of diabetes to education and care services that are consistent and
based on best practice. The report also demonstrates the continued evolutionary process for supporting
increased capacity of the general hospitals and larger community hospitals to provide specialist diabetes
education and care while integrating with general practice to support primary care.
Highlights of 2010
> Interdisciplinary workshop days held in 4 main centres (Riverland, Pt Lincoln, Whyalla / Pt Augusta and Mt
Gambier).
> 592 rural and remote health professionals accessed the face-to-face regional education series in
their local area. An increase of nearly 200 (30%) on 2009.
> 45 of the above participants were Aboriginal health workers or health professionals working in an
Aboriginal health service.
> Introduction to Diabetes course that was offered via audio conferences
> 23 Aboriginal health workers took part in a new series that was developed and offered for the first
time in 2010.
> 14 health professionals undertook the course that was aimed specifically at nurses and allied
health.
> Advanced Continuing Education Program was offered monthly via video conferencing. The program
registered 317 attendances over the course of the year.
> The Country Health SA Diabetes Network continued to meet monthly via teleconference and a 2 day face to
face workshop was held in July. Of the 20 members 18 were able to attend and participate in the workshop.
> Implemented an education program for use by diabetes educators to support best practice in individual or
group self management education (Diabetes Self Care Program). Diabetes Australia-Queensland has sought
permission to use the program.
> Research investigating current diabetes educator network activities in the 11 rural clusters and report
forwarded to CHSA.
> 122 Diabetes Manuals were distributed.
> 59 Diabetes Education Update workbooks for registered nurses were distributed (3 times the number
distributed in 2009). This workbook has been reviewed and updated. Renamed Diabetes Fundamentals and
will be available as an online module.
> Diabetes Management Portfolio reviewed & updated.
> Review of factsheets continues.
> 52 SA country health services accessed resources via the website.
> 1136 subscribers to the Diabetes Network News, including 70 Aboriginal health workers.
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235 health professionals are registered to receive the monthly e-newsletter ‘Diabetes Update’. Diabetes
Update now available on website as a download.
> Regional diabetes profiles were updated, and as part of the update a new template has been designed to
enable future profiles to include data about type 1 diabetes and diabetes in pregnancy including gestational
diabetes and pre-existing type 1 and type 2 diabetes in pregnancy.
> Continue to participate in the statewide project group for the Gestational Diabetes Recall and Register.
> Staff completed the Flinders Chronic Condition Management Program and completed the certificate of
competence. Staff are now licensed to use The Flinders Chronic Condition Management Program Tools.
> Provided diabetes education sessions for Australian Practice Nurse Association – SA Conference.
> Presented at Quality Assurance for Aboriginal Medical Services (QAAMS) Conference.
> Presented to Masters Dietetic students at Flinders Medical Centre.
> Presented to Practice Nurses as invited by GPSA.
> Presented to post graduate students as part of the Graduate Certificate Diabetes Education at Flinders
University.
> Staff attended various Adelaide-based diabetes conferences and workshops sharing success and learning
new ways of working.
> Staff presented at the Australian Diabetes Society / Australian Diabetes Educators Association Annual
Scientific Meeting.
> Publications, presentations and research (Attachment A).
Proposed 2011 Priorities
Diabetes Outreach programs and activities for 2010 have highlighted a range of work priorities for 2011.
These priorities fall into the complementary strategies which form the framework in which Diabetes Outreach
achieves its vision.
Whole-of-population approach
Ongoing
Continue to source and use data including the Diabetes Regional Profiles to inform local and regional service
planning.
Continue to use population data to inform service re-orientation and service strategic planning.
New
Implement the newly developed template for profiling diabetes to assist in cluster service planning that
enables the inclusion of gestational diabetes, paediatric and adult type 1 diabetes, and pre existing diabetes
in pregnancy.
Standards of care
Ongoing
> Use of national & international standards to inform education material and programs as well as
continued support for ADEA credentialling of rural and remote educators.
> Continue to work with all key stakeholders to develop care and education pathways based on the
best available evidence, agreed guidelines, and making best use of local resources.
> Maintenance of clinical, educational and professional support for country health professionals.
New
> Monitor usage of the Diabetes Self Care Program (new consumer education program for individual
or group).
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Training and support
Ongoing
New
> Continuation of partnerships with University of South Australia, Flinders University SA, Spencer
Gulf Rural Health School and Flinders University Rural Clinical School in the provision of initial
training, continuing education and special projects.
> Continuation of effective models of education and support.
> Regional education workshops in the 4 key regional centres.
> Facilitate access to the online program for general staff development called Diabetes
Fundamentals: An update to diabetes.
> Provide advanced continuing education via multisite video conference.
> Continued partnership with metropolitan-based medical, nursing and allied health specialists.
> Continue to support diabetes education clinical networks (Country wide and cluster).
> Support and monitor implementation of the online education program to support best practice in
sick day education for people with type 2 diabetes.
> Develop education podcasts for website.
> Monitor implementation of Diabetes Fundamentals online.
> Offer the newly developed ‘Introduction to diabetes’ course for Aboriginal health workers via audio
conference over 14 weeks.
> Develop and provide ‘Introduction to diabetes’ course via audio conference specifically for nurses
working in the general practice environment.
> Review recommendations of the Diabetes Network Report as provided to CHSA in March 2011.
Professional and consumer resources
Ongoing
> Continue to review and update consumer and professional resources.
> Continue to identify new opportunities for resources with a particular focus on low literacy.
> Keep resources available free online.
> Continue to provide Diabetes Update (monthly electronic newsletter) as web download.
> Continue to provide Diabetes Network News (quarterly publication) as web download.
New
> Complete review of consumer resources.
> Complete review of ‘Dealing with Diabetes’ staff development powerpoint teaching pack.
> Undertake review of ‘Pre-diabetes’ community education powerpoint teaching pack.
Network collaboration
Ongoing
> Attend and support cluster diabetes education network meetings as needed.
> Provide leadership to the Country Health SA Diabetes Education Network.
> Work closely with Country Health SA.
> Liaison with General Practice SA and rural Divisions of GP to support an integrated and
multidisciplinary approach to diabetes and a seamless patient journey.
> Liaison with Aboriginal Services Division, Aboriginal Health Council and individual Aboriginal
Health Services to maintain and further develop links and educational opportunities for health
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workers, that supports an integrated and multidisciplinary approach to diabetes and a seamless
patient journey.
New
> Review recommendations from Diabetes Network report 2010.
Quality assurance and documentation
Ongoing
> Continue to support health professionals to meet their professional requirements in the areas of
clinical practice, education provision, documentation, service accountability and service reorientation.
New
> Work with Diabetes Steering Group and CHSA to improve guidelines for inpatient care
> Undertake an evaluation of the usability of the Diabetes Management Portfolio.
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Background
Diabetes Outreach is an off site program of Country Health SA and co-located at The Queen Elizabeth
Hospital, Diabetes Centre. The service provides and facilitates health care provider continuing education
and support programs as well as consultancy and assistance with rural diabetes service planning thereby
building the capacity of rural and remote health services in providing best practice diabetes education and
care.
Diabetes Outreach works towards its aim by working with a state-wide interdisciplinary network of
organisations and individuals involved in diabetes education and care. These organisations include Rural
and Remote Hospitals and Health Services, Aboriginal Health Services and General Practice. Programs
focusing on capacity building and quality and safety by utilising a range of distance education and support
models (Attachment B). All programs are based on best practice. Best practice in this context is defined to
be the use of evidence based medicine to underpin a consistent level of service which would be expected at
each service. Diabetes Outreach is currently funded via a Site Specific Grant from SA Health.*
The key principles for both Country Health SA service planning and the Strategy for Aboriginal and Torres
Strait Islander People are outlined below and underpin the work of Diabetes Outreach.
Principles for Country Health SA service planning 1 ;
> Focussing on the needs of patients, carers and their families.
> Ensuring sustainability of country health service provision.
> Ensuring effective communication with local communities and service providers.
> Contributing to equity in health outcomes.
> Providing a focus on safety and quality.
> Recognising that each health service is part of a total health care system.
> Maximising the best use of resources.
> Adapting to changing needs.
> Improving Aboriginal health status.
Strategy for Aboriginal & Torres Strait Islander people 2 ;
> To implement regionally coordinated knowledge management processes.
> To develop collaborative diabetes implementation plans.
> To provide coordinated ongoing workforce development programs.
> To develop and implement effective organisational capacity building initiatives.
Both strategies reinforce the need for an integrated and cooperative approach as well as a seamless patient
journey.
* 2009-10 Budget $429,639
Medical 0.1 FTE
Nursing 2.0 FTE
Admin 1.8 FTE
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Diabetes is one of the fastest growing chronic diseases in Australia. The burden of diabetes is also much
greater for people in low socioeconomic circumstances, Aboriginal people and those from rural and remote
areas. For the above groups there are higher levels of disability, morbidity and mortality 3 4 . Data highlights
that;
> In 2007, South Australia had 82,500 adults (age 16 years and over) living with diabetes in rural and
remote South Australia 5 . This is a 15% increase from 2003.
> Diabetes complications are the leading cause of potentially avoidable hospitalisations in South
Australia in 2005/06 and 2006/07 6 .
> Comparisons done between metropolitan Adelaide and rural and remote South Australia in June
2005 found the prevalence of diabetes to be significantly higher in rural and remote South
Australia, 10.2% compared to 7.8%, a 2.4% difference 7 .
> Persons living in rural and remote regions generally have worse health, in terms of mortality,
hospitalisation rates and risk factors compared to those living in metropolitan areas 3 .
> South Australia has the most geographically isolated Aboriginal communities in Australia 8 .
> Diagnosis of diabetes in Aboriginal people in 2004-05 were double that of the non-Aboriginal
population 9 .
> There are 191 children living in rural and remote South Australia with type 1 diabetes, 29 of these
are on insulin pump therapy 10 . 127 young adults between the age of 18 and 25 with type 1
diabetes are living in country South Australia, with 64 of these on insulin pump therapy 10 .
> Diabetes shows up some 10 years earlier in Aboriginal people than non-Aboriginal people.
Diabetes Outreach aims to improve health for rural and remote South Australians by supporting the capacity
of local health professionals in providing evidence based diabetes education and care. Diabetes Outreach
has six complementary strategies to achieve this.
> Adopting a whole-of-population approach.
> Developing and promoting standards of care.
> Training and support for health professionals who provide care and education to people with diabetes and
those at risk of diabetes.
> Developing and maintaining professional and consumer resources.
> Supporting and promoting local and statewide networking and collaboration.
> Promoting quality assurance and appropriate documentation.
The vision of Diabetes Outreach is:
“Better health for rural and remote South Australians by supporting health service providers towards
best practice in diabetes care.”
The 2007-2008 Country Health SA Service Agreement has formed the framework for the presentation of this
report (Attachment C).
The Service Agreement is currently under review.
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Diabetes Outreach in 2010
Whole-of-population approach
The continuum of diabetes care and education requires a whole-of-population approach and regional
planning based on local resources.
Diabetes Outreach utilises data from the Population Research and Outcomes Studies Unit of SA Health, in
developing and providing population profiles. Other sources of data include the Pregnancy Outcomes Unit
(SA Health), Australia Institute of Health and Welfare and the National Diabetes Service Scheme National
Register. The profiles contain specific diabetes epidemiological and service data including prevalence and
incidence rates for diabetes, prevalence of those with risk factors for complications, hospital admissions, etc.
The profiles are available at www.diabetesoutreach.org.au. Data about gestational diabetes, type 1, and
paediatric diabetes is somewhat limited and is identified as a gap.
A profile based on all types of diabetes and not simply type 2 diabetes will enable services to effectively plan
for reorientation to meet current and changing needs. Diabetes Outreach has so far assisted the Northern
Yorke Peninsula and Ceduna area in developing a local population profile of diabetes.
Standards of care
Diabetes Outreach continues to incorporate evidence based professional standards of diabetes care into all
education, support and consultative activities. The service also contributes to the development and updating
of these standards in the medical, nursing and allied health professional arenas.
Diabetes Outreach staff are working with CHSA in identifying issues related to consistency and safety of
care in rural hospitals. The lack of constant protocols to guide care of inpatients has been highlighted as an
area of concern. Consultation with key stakeholders about best options has commenced.
The Diabetes Outreach - Diabetes Self Care Program is now freely available online.
http://www.diabetesoutreach.org.au/7Steps/default.asp
Underpinned by work undertaken by the American Association of Diabetes Educators the program supports
behavioural & clinical outcomes. Rural diabetes educators can now have access to program outlines and
tools that support the delivery of an evidenced based approach to self care education in either a group or
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individual format.
Template documents and flow charts, such as those found in the Diabetes Management Portfolio and the
Diabetes Manual continue to support evidence standards of care. These resources can be adapted and used
to support quality and safety in all health services as well as a seamless patient journey between public and
private services.
Role definition
In 2010, Diabetes Outreach has continued to work with all areas to incorporate accepted national
professional standards and guidelines for diabetes using local diabetes pathways. Guidelines and standards
are necessary but not sufficient on their own. Application in everyday practice requires agreed clinical and
educational pathways. The ‘what should be done’ by ‘whom’, ‘when’ and for ‘how long’ are all aspects of
local service delivery which can only be agreed at a local level. These pathways need to be developed for,
and by, each individual area since needs, priorities and available resources vary.
As the number of credentialled diabetes educators (CDEs) grow in rural and remote areas it becomes
necessary to clearly articulate roles and responsibilities. CDEs are advanced practice registered nurses who
are well placed to provide specialist diabetes education and care as well as a level of professional support to
general nurses and allied health professionals. The Australian Diabetes Educators Association, The
Credentialled Diabetes Educator in Australia: Role and Scope of Practice document is being used to
benchmark professional practice and service delivery.
Diabetes Outreach provides education and support re the integration of services as well as an understanding
of role definition and specialist practice.
Training and support
Training and support is core business for Diabetes Outreach. Rural and remote colleagues need ready
access to initial training and orientation as well as continuing education and practice development. Training
and support is also integrated into the clinical networks and clinical governance activities.
Initial training
Diabetes Fundamentals has been available as a workbook since 2003. The workbook was reviewed and
updated in 2007, and was offered as a self directed learning model for reviewing and updating diabetes
clinical and educative information. It also provides resources for service provision and professional practice.
The workbook is used together with the Diabetes Manual and peer/professional support through the diabetes
clinical networks and Diabetes Outreach.
During 2010 the package was requested by 59 registered nurses (Attachment D).
The workbook has also been modified for use in The Queen Elizabeth Hospital, Diabetes Resource Nurse
training program.
In 2010 the material underwent a significant review and has been converted to an online program to increase
access. Other changes included greater emphasis on the interdisciplinary approach to the material enabling
access for dietitians, podiatrists and other allied health professionals. The online program will be available
early in 2001.
Introduction to diabetes program: provides diabetes professional development in a distance education
model utilising a combination of audio conferencing and workbook. The program suits health care providers
who wish to undertake basic up-skilling but are unable to take on a university commitment at that time. An
external package of material includes 7 topic sessions with topic discussion, case activities and extra
reading. Seven 1 hour telephone tutorials offer group discussion for each of the topics. In 2010 the program
attracted 37 participants from a range of rural areas (Attachment E). A new program specifically for
Aboriginal health workers was also developed. Evaluations stated that the program had a positive impact on
the way they provided information to and cared for people with diabetes (Attachment F). Three programs
are planned for 2011. One for general health professionals, one specifically for Aboriginal health workers and
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one for nurses working in general practice.
The ‘Graduate Certificate in Health (Diabetes Education)’ offered at Flinders University South Australia is
the only Australian Diabetes Educators’ Association (ADEA) accredited tertiary program for diabetes
educators in South Australia. Flinders University SA administers the program with educational input from a
range of metropolitan health services including Diabetes Outreach.
Professional staff of Diabetes Outreach has continued to contribute to the teaching program in all 3 modules
of the course. Sessions included pathophysiology and management of diabetes, resources for health
professionals and for people with diabetes, program evaluation and data collection as well as teaching and
learning modules and packages.
Diabetes Outreach staff have continued to provide mentoring and support to rural health professionals and
Aboriginal health workers undertaking the program.
Continuing professional development
The ‘Diabetes Outreach Regional Education Series’ incorporates a interdisciplinary, face-to-face program
in each of the main country areas. The target group includes diabetes specialist and generalist health
professionals, health workers, general practitioners, Aboriginal health workers and health professional
students. Educational formats vary depending on need e.g. lectures, open forums and practice visits with
case discussions. Education topics and programs are designed in consultation with key stakeholders to
meet the educational, organisational, and professional and population needs of each area.
The 2010 program was run in 4 areas. Participants (n. 592) came from a wide range of health professional
backgrounds and a variety of service locations (Attachment G).
Four key health areas (Northern, Eyre, Riverland and South East) are now conducting one day workshops
that attracted a wide range of health professionals from both public and private areas of health. Partnerships
with the Spencer Gulf Rural Health School and the Flinders University Rural Health School has increased
access for medical, nurse and allied health students. Evaluation feedback from hospital, general practice
and community health showed positive planned practice changes (Attachment H).
As part of supporting local capacity building, in some areas, community talks are presented in partnership
with credentialled diabetes educators. Community feedback was also collated (Attachment I).
‘Advanced Continuing Education Program’ is a series of topics and discussions offered by multi site
video conferencing and led by specialists in the field of diabetes and related areas. The series is designed
to make available advanced, evidence based information about diabetes to rural and remote health
professionals (the type of information which is often only available at metropolitan based conferences and
workshops). The aim of the program is to support the continued knowledge/skills and practice development
of health professionals who are credentialled diabetes educators, dietitians, podiatrists or those who have
completed initial education and wish to further their knowledge and expertise in diabetes.
In 2010, a series of 10 sessions were conducted in partnership with specialists based in metropolitan
Adelaide (Attachment J). There were 317 attendances that included diabetes educators, nurses, dietitians
and general practitioners from 13 different sites (Attachment K). Evaluations and early registrations for 2011
show continued interest and value in this program. A program for 2011 is provided (Attachment L).
General video conferencing access is offered to meet specific local needs. Sessions included:
> clinical case conferencing with GP’s and local educators
> participation in network meetings
> linking remote centres to metropolitan based specialty areas.
The Internet and website based program continues to provide a means of facilitating equity of access for
rural and remote health professionals. Factsheets, teaching packs and template forms are freely available.
An interactive online activity providing education about sick day management and prevention of hospital
admissions through poor self management has been developed. This project is funded via a Novo Nordisk
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Regional Support Scheme Grant awarded to Diabetes Outreach in 2008.
The Diabetes Fundamentals workbook has been reviewed and converted to online modules.
Professional orientation
Diabetes Outreach supports the provision of practical and professional orientation in diabetes education.
The Queen Elizabeth Hospital, Lyell McEwin Hospital, Flinders Medical Centre and Royal Adelaide Hospital
diabetes centres continue to make their services available for clinical placements. These placements enable
rural and remote health professionals to gain extended experience. 2010 saw a continuation of support from
the metropolitan diabetes centres and clinical managers.
Qualifications recognition
Diabetes Outreach continues to align programs with Australian Diabetes Educators Association
credentialling and re-credentialling requirements. These programs give specialist diabetes health
professionals an opportunity to meet ongoing professional requirements for ADEA. It also supports nurses in
meeting their requirements for the Nurses Board registration. The framework includes self directed learning
packages linked with peer support and review opportunities. All have been developed in consultation with
rural and remote health professionals. Self assessment tools give participants an opportunity to request
ongoing review and constructive feedback as well as the opportunity to develop individual learning programs.
In 2010, country South Australia now has approximately 12 credentialled diabetes educators working in rural
or remote centres.
Peer, professional and resource support
The published Strategy for Planning Country Health Services in South Australia 1 is based on a premise that
health care services of different sizes work together to ensure a wide range of services are available within a
‘local clinical network’. By supporting health services within the local clinical network to work together,
services to the community will be optimised and issues such as workforce shortages, safety and quality, and
recruitment and retention can be addressed collectively. Diabetes Outreach has worked with clusters of
health services to support consistent best practice in diabetes education and care in a geographical area.
Specialist diabetes peer support provided through the diabetes clinical networks is an integral aspect of
health professional development. Diabetes Outreach staff readily support local clusters and can attend
meetings by either face to face or by audio and video conferencing.
There are currently 11 clinical networks aligned with the CHSA clusters. Communication pathways have
been set up in the majority of networks. Diabetes Outreach in 2010 investigated issues related to cluster
networks and a report was sent to CHSA in October.
Key outcomes of the Networks include the provision of diabetes clinical and resource support, the support
and active involvement in a consistent and evidence based approach to education and care, as well as
service/regional planning.
Professional support through the provision of advice on diabetes practice issues and clinical support to the
networks. Diabetes Outreach staff receive approximately 8-10 calls per week from rural and remote areas
for clinical advice, resource advice and general information requests.
Requests for information are also received from metropolitan hospitals, SA Health, Country Health SA and
General Practice SA. To a lesser degree, staff receive requests from interstate organisations.
Internet support and electronic communication is an established part of Diabetes Outreach activities. Email
provides information to individual health professionals and the email discussion list facilitates health and
practice information discussion and problem solving. Email also gives country health professionals access
to a number of metropolitan-based health professionals. The Diabetes Update is now available on the
website and back issues are easily accessible.
There are now 235 health professionals registered to receive the monthly newsletter ‘Diabetes Update’.
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Professional and consumer resources
Resources for consumers and professionals are an important aspect of diabetes education and care.
Education of people with diabetes, their families and the community requires a range of resources identified
as appropriate for various teaching and learning experiences. These resources are linked to the training and
support aspects of the Diabetes Outreach program.
Resource support includes the development and review of consumer and professional educational
resources (Attachment M). The service continues to provide access for health services to up-to-date
diabetes education resources for people with diabetes, teaching packages and manuals for health
professionals.
The ‘Diabetes Manual’, is a comprehensive guide of diabetes care and practice for health units and health
professionals. The manual underwent a comprehensive update in 2009 and continues to be available free of
charge via the website. 122 manuals were distributed in 2010. The NSW Greater Western Area Health
Services and the WA Great Southern Area Health Service have continued to endorse and implement the
Manual for use in all their health services.
The ‘Diabetes Self Care Program’, is a newly developed online resource to support self care education.
The program is designed to provide a framework and tools for diabetes educators to delivery group and
individual education that supports clinical and behavioural outcomes. The program is free online at
http://www.diabetesoutreach.org.au/7Steps/default.asp
In November, Diabetes Australia-Queensland formally sort permission to use the self care program.
Acknowledgment of the developers and CHSA has been secured.
The ‘Group Education Package’ is a DVD and workbook designed to build group facilitation and teaching
skills for health professionals. There have been 22 packages distributed to key education sites in rural and
remote South Australia in 2010.
The diabetes continuing education overhead package, ‘Dealing with diabetes: A resource for staff
development’ continues to be widely accessed and is available free of charge from the website. A
comprehensive review and update has been commenced in 2010 and is due to be completed early in 2011.
A teaching and overhead package ‘Impaired Glucose Tolerance’ is also available via the website free of
charge. The package is undergoing a comprehensive review and update, and will be re-named, Pre-
Diabetes in 2011.
The ‘Diabetes Education Factsheets’ for consumer education continue to be reviewed on at least a 2
yearly basis, with 13 factsheets being reviewed in 2010 (Attachment N). Factsheets are available on the
website free of charge. 2011 will see the completion of a comprehensive review of consumer resources.
‘Diabetes Rural Directory’ continues to be a valued resource for metropolitan endocrinologists and
diabetes services. The resource facilitates appropriate referral back to rural centres from metropolitan
Adelaide by providing rural contact information. There are now 17 health services (metropolitan
endocrinologists, diabetes educators, etc) who receive updates.
‘Diabetes Network News’ is a quarterly publication distributed to 503 rural and remote health professionals
(diabetes educators, dietitians, podiatrists, hospital/community health/general practice nurses, Aboriginal
health workers), 633 metropolitan health professionals, 70 Aboriginal health care providers, 19 interstate
professionals, 22 pharmaceutical companies and 8 international health professionals. A total of 1136. This
resource is also available online.
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Network collaboration
Diabetes Outreach continues to initiate, facilitate and participate in a wide range of professional and
consumer networks. These networks facilitate multi-level, intra disciplinary and inter-sectoral collaboration.
Network support is also linked into the training and support programs as well as the resources to support
education.
The Country Diabetes Educator Network was established in 2009. This network brings together key
educators from each of the 11 rural clusters. The purpose of this network is to promote a collaborative,
standardised and evidence based approach to diabetes education and support across public and private
health services in country SA (Attachment O).
The network meets monthly via teleconference and in July the network was brought together for a face to
face 2 day workshop. The workshop provided an opportunity to formalise the terms of reference, the
membership and roles and responsibilities of participants. The network has worked together in 2010 to
address some key concerns raised by its members, namely
> inconsistencies in coding for CME data
> lack of support documents for titration of insulin in outpatient settings
Nursing and allied health diabetes networks have continued across rural and remote South Australia. As
already stated, there are currently 11 clinical networks.
Key outcomes of local/cluster clinical networks focus on communication across both public and private
health services to ensure an appropriate and timely patient journey, support for consistency in diabetes
clinical activities and resource support, and to have a consistent and evidence based approach to education
and care.
Diabetes Outreach attends meetings as needed. Video conferencing or audio conferencing is used to
participate in some meetings where travel and time constraints prevent attendance. Some areas need to
address leadership and resource allocation issues to enable appropriate local collaboration.
Links with general practitioner networks through General Practice SA (GPSA) and individual country
divisions of general practice enable collaboration with regional health services and local Aboriginal Health
Services. These networks are invaluable as they enable divisions, regional health services, and Aboriginal
Health Services to plan service delivery models that meet the needs of communities and key stakeholders.
Aboriginal health worker networks were initially established by the Aboriginal Health Partnership and
coordinated through Health Promotion, SA Health. These networks have not been functioning since 2004.
Diabetes Outreach has however, continued to communicate and work with Aboriginal Health Services via the
education programs with the view that the networks will eventually be reactivated.
Country Health SA, SA Health network continues to be central to planning and development. Meetings with
key personnel and other divisions have been limited due to SA Health restructure. These meetings when
undertaken enable planning in the context of statewide priorities.
Other groups, committees and projects that Diabetes Outreach staff are involved in are:
> Australian Diabetes Educators Association
> Diabetes Australia Limited
> Diabetes in Schools project with CYHS, DECS, Flinders Medical Centre, Lyell McEwin Hospital and RDNS
> Primary Health Care Advisory Committee, FUSA
> General Practice, SA
> CNAHS GP Plus Advisory group
> SA Health Gestational Diabetes Register and Recall working group
> Aboriginal Health Council
> Quality Assurance for Aboriginal Health Services (QAAMS), Flinders University, SA.
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Quality assurance & documentation
Quality assurance and documentation are essential if quality and safety standards and continuity of care are
to be maintained.
Supporting diabetes education practice with a system that triggers appropriate care, documentation and
referral is essential. The Diabetes Management Portfolio provides a template to assist in all aspects.
The Diabetes Management Portfolio has undergone a significant review and update with additional
templates included as an outcome of a needs assessment. These templates include cycle of care review,
commencement of insulin therapy checklist, gestational diabetes education sheet and foot risk assessment
documentation. The package remains available to all diabetes health professionals and health workers, and
can be accessed via the website.
Professional activities
Diabetes Outreach staff are involved in a range of professional activities. These activities provide
opportunities for the staff to extend their learning, skill and expertise as well as giving an opportunity for
Diabetes Outreach to share its work and the lessons learned (Attachment A).
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Attachment A
Diabetes Outreach – Professional Activity Report - 2010
Professional development undertaken
Australia Diabetes Educators Association, Sa Branch, Weekend conference
Australian Diabetes Society/Australia Diabetes Educators Association, Annual Scientific Meeting
SA Refresher Day
Flinders University, Chronic Condition Self Management, Certificate of competency.
South Australian Community Health Research Unit, Research mentoring
Publications
Giles J (2010) Nursing roles in initiating and adjusting insulin, Diabetes Management Journal, Vol 32
Visentin K (2010) Quality use of medicines resources, Diabetes Management Journal, March, Vol 30,
Posters
Conference title and date Title of poster Author/s
Australian Diabetes Educators
Association Annual Scientific Meeting,
Sydney, August / September 2010
Developing an online diabetes
competency assessment
Visentin K, Barrie D,
Bishop L, Kupke K,
Moore G, Pech D,
Zanker E, Turrell M
& Giles J.
Presentations
Conference title and date Title of talk / presentation Author/s
Quality Assurance in Aboriginal
Medical Services(QAAMS) National
workshop, Adelaide SA
Australian Practice Nurse Association
annual conference, Adelaide SA
NovoNordisk SA Statewide
Symposium, Adelaide SA
Matching education to medical
management.
Current trends in management of
neuropathy and foot care in
people with diabetes
Type 2 diabetes and blood
glucose monitoring.
Giles J
Visentin K
Giles J
General Practice SA annual workshop,
Adelaide SA
Support infrastructure for rural
diabetes services.
Giles J
Grants
No grants received in 2010
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Attachment B
Current Programs & Services - 2010
Continuing education
Regional education workshops
Introduction to diabetes
Advanced continuing education
Diabetes fundamentals
Group education training
Multimedia resources
University programs
Resources
Professional
Teaching and overhead
packages
Website
Consumer
Support
Network support
Aboriginal health
Clinical support / case
conferencing
Communication
Diabetes Networks News
Diabetes Updates
Mailouts
> Face to face (nursing & allied health, Aboriginal health,
community, general practitioners.
> Entry level, short course – distance model (teleconference
and workbook).
> Specialist series offered by multi site video conferences.
Case discussion / clinical support.
> Self directed online for general nurses and allied health
professionals.
> Group education skills development (DVD & workbook).
> DVDs, CDs and audio files.
> Flinders University of South Australia.
> University of South Australia.
> Statewide Diabetes Manual.
> Rural Directory.
> Healthy Eating & Diabetes Kit.
> Diabetes Management Portfolio (forms and templates).
> Diabetes Self Care Program (consumer education).
> Pre- diabetes package (consumer group education).
> Dealing with Diabetes (staff development).
> Resources online free of charge.
> Diabetes information factsheets.
> Booklets & audio CD’s.
> CHSA Diabetes Education network.
> Cluster networks.
> Video conferencing.
> Continuing education and support.
> Video conference, audio conference, email and telephone.
> Quarterly publication.
> Monthly newsletter.
> On specific information.
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Attachment C
Extract from last Service Agreement - 2007 – 2008
Services:
Services provided by Diabetes may be broadly categorised as follows.
Training and support
> Provision of regional diabetes education programs utilising both face to face and distance education
delivery models.
> Initiation, development and maintenance of self directed workbooks for health care providers.
> Provision of specialist diabetes videoconferencing sessions in partnership with metropolitan-based
medical, nursing and allied health specialists in diabetes.
> Development of new distance diabetes education programs and resources as identified in regular needs
assessment and industry trends.
Network collaboration
> Provision of network support for rural health professionals including nursing, allied health, Aboriginal
health workers and general practitioners.
> Provision of advice to facilitate professionals’ ongoing consultation with consumers.
> Promotion and maintenance of communication with and between rural health professionals through
publications, both electronic and hard copy.
> Promote the use of Internet and electronic communications.
> Maintaining awareness of regional profiles and implications for regional diabetes care.
Promotion of standards of care
> Collaborate in the development and updating of professional standards of diabetes care, with particular
focus on issues relevant to South Australians in rural and remote areas.
> Supporting the incorporation of accepted national professional standards and guidelines into local diabetes
care pathways.
Promotion of quality assurance and documentation
> Provision of record keeping tools, policy, forms and checklist templates.
Resources
> Develop and maintain diabetes education resources for people with diabetes and those at risk of diabetes.
> Develop and maintain diabetes education resources for health professionals.
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Attachment D
Diabetes Fundamentals (staff development) – 2010
Cluster
Total
Hills, Southern & KI 4
Barossa, Gawler, Eudunda, Kapunda 3
Eyre & Western 3
South East 3
Mallee Coorong 3
Pt Augusta, Flinders, Roxby, Woomera 7
Mid North
Riverland
Whyalla, East Eyre & Far Nth 2
Yorke & Lower North 2
Metro Adelaide 28
Interstate 3
59
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Attachment E
Introduction to diabetes (nurses & allied health) – 2010
Region Professional Mix Total
Hills Mallee & Southern
Kingscote RN x 3 3
Mid North
Peterborough RN x 1 1
South East
Mount Gambier Podiatrist x 1 1
Eyre Peninsula
Wudinna RN x 1 1
N & FW
Coober Pedy
Pt Augusta
RN x 1
RN x 5
EN x 1 7
Interstate
Alice Springs RN x 1 1
Total participated 14
Introduction to diabetes (Aboriginal health workers) - 2010
Hills Mallee & Southern
Victor Harbor AHW x 1 1
Wakefield
Moonta
Maitland & Point Pearce
RN x 1
AHW x 1
EN x 1
EN x 2 5
Mid North
Port Pirie AHW x 6 6
Riverland
Berri AHW x 1 1
South East
Mount Gambier AHW x 3 3
Eyre Peninsula
Ceduna AHW x 2 2
N & FW
Whyalla AHW x 3 3
Interstate
Alice Springs AHW x 2 2
Total participated 23
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Attachment F
Introduction to diabetes 2010 - Final Evaluation
General health professional course
Please comment on any negative experiences you may have had as a participant.
> Teleconferencing difficult in knowing when able to speak.
> Would have preferred sessions during the day when I was at work.
> Lots of reading.
Please share any positive experiences.
> The convenience of doing the program from home in the comfort of my bedroom.
> Learnt new practices.
> Learnt what other hospitals are doing.
> Great feedback of activities and peoples experiences within their workplace.
> Increased knowledge.
Please state 3 areas of practice you have changed since commencing the series.
> Attitude towards people with diabetes has changed, less judgemental now.
> Very aware now of avoiding words that imply failure to the person with diabetes.
> Not to use insulin pens on patients if they are unable to do it themselves.
> Nightly checking for glucose monitors.
> Better education to clients.
> Education.
What topics would you like covered in future diabetes continuing education programs?
> The coverage of topics is very good.
> A little more information on medication compliance strategies.
> Topics on assisting diabetics accepting their diagnosis and support available for them.
> Peri-operative management.
Results of phone interviews with Aboriginal health workers
Were there any barriers to attending the sessions?
> Afternoons not a good time
> Management support was important to ensure people could get to sessions
> Session finished too late for some workers who finished at 4 pm.
> Difficult when only working part time
> Difficult to take time away from clinics
> Would prefer face to face
How useful was the study guide?
> Easy to follow and understand eg layman’s terms
> Well structured
> Liked the pictures especially of Indigenous people
> Good information
> Useful to use as a follow on reference as there is lots of information
> Interaction with the book
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Attachment F
> Reinforcement as well as new information
> Was a bit of reading but it was not overwhelming
> There was an overabundance of reference sites
> Thought extra readings was an overload
> Could have more colour and pictures
> Complication pictures would be good.
> Lots of reading – would have preferred more clear and compact study guide
Guest presenters and facilitation
> Good facilitation
> Good communication
> Helped to know other participants
> The whole program was well thought out
> Felt safe
> Was helpful hearing what happens in other services
> Easy to understand (clearly explained questions and answers)
> Discussion was good
What didn’t work well
> Some participants were quiet.
> Being at work meant that it was easy to get distracted.
> Sometimes got stuck on scenario and didn’t get to the others. Time limit on questions.
> Would have liked to have seen participants.
What did you want more of?
> More practical eg guidelines
> Information about participants can do this week to build their skills and knowledge
> Extra sessions (more than 1 session per topic) (x2)
> Case scenarios
> Consolidation in the field
> Follow up session
> Renal dialysis
> Session on prevention
> Discussion on bush tucker
> Information about other health services
> Sharing of service information and finding out more about how others work
> Visual on insulin and blood glucose monitoring
> Extra time in first session for meet and greet
Did the audioconferencing program meet the participants needs?
All the participants interviewed felt that the program met their needs. Some have felt as if they have had an
opportunity to put what they learnt into practice. Medications were an area which was singled out in terms of
learning outcomes and the need for more up-skilling in this area. One participant stated that she now better
understands how insulin and medications work. Another liked the way the program started with ‘what is
diabetes’ and worked through to complications. Another person commented that although they were nervous
at first this eased when he realised that he knew some of the other participants.
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Summary
The data obtained through interviews and the written survey from the health professionals and the Aboriginal
health workers have provided direction for future courses. In response to the feedback we have made the
following modifications:
> The Aboriginal health worker course has been reviewed and the study guide has been rewritten with more
pictures, diagrams and the activities are more culturally appropriate. Advice on the study guide has been
sought from other health care providers who specialise in the area of Aboriginal health.
> The Aboriginal health worker course has been extended from 7 weeks to 14 weeks to give the participants
more support in applying theory to practice.
> The actual session length has been extended to include more time for discussion and introductions.
> A third series has been planned that will focus on the needs of practice nurses.
Attachment F
> A wider range of guest speakers have been sourced to reflect the needs of Aboriginal health workers and
country health professionals.
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Attachment G
Regional Education Series - Attendance and Locations
Participants attended – 592
Region Professional Mix Total
Riverland
Renmark
Health Professionals
Paramedical student x 2
Medical student x 8
RN x 16
Nurse assistant x 2
Nursing student x 9
Practice nurse x 3
EN x 6
DE x 1
Dietitian x 3
Dietitian student x 2
Dietitian x 3
Podiatrist x 2
Medical student x 7
64
Berri
GP’s
GP x 10
DE x 1
PN x 4
Pharmacist x 2
Medical student x 4
21
Eyre Peninsula
Pt Lincoln
Health Professionals
EN x 5
RN x 11
Podiatrist x 2
Dietitian x 2
Lifestyle Coordinator x 2
DE x 4
Nurse student x 6
Aboriginal Health Worker x 3
Medical student x 3
38
GP’s
GP x 11
Physician x 1
DE x 2
Aboriginal Health Worker x 2
PN x 8
RN x 9
Podiatrist x 1
Pharmacist x 8
42
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Attachment G
Aboriginal Health DE x 1
Aboriginal Health Worker x 5
RN x 2 8
Northern & Far West
Broken Hill
Health Professionals
DE x 6
EN x 8
RN x 15
Dietitian x 4
Podiatrist x 2
35
GP’s
GP x 15
DE x 8
Dietitian x 4
Aboriginal Health Workers x 8
Podiatrist x 2
Medical student x 4
EN x 7
RN x 12
60
Whyalla
Diabetes Team
CDE x 1
DE x 1
Dietitian x 3
Podiatrist x 2
Team Leader x 1
8
GP’s
GP x 1
DE x 1
RN x 6
Dietitian x 3
Medical student x 2
13
Health Professionals
EN x 2
RN x 15
Dietitian x 1
PN x 2
Pharmacist x 1
DE x 2
Aboriginal Health Worker x 6
Nursing student x 2
Health assistant x 4
35
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Pt Augusta
Fellowship Learning Group
GP x 4
4
Attachment G
GP’s
GP x 17
DE x 2
PN x 7
Pharmacist x 9
Dietitian x 1
Podiatrist x 1
37
Community
Community
30
Aboriginal Health
EN student x 3
DE x 3
Lecturer x 1
Aboriginal Health Worker x 3
RN x 2
12
Diabetes Team
DE x 2
Podiatrist x 1
Dietitian x 1
4
South East
Naracoorte
Health Professionals
Penola
GP’s
Mt Gambier
Grand Round
NP Diabetes x 1
CDE x 2
DE x 4
RN x 28
EN x 12
Dietitian x 3
Podiatrist x 2
Carers x 8
GP x 14
NP Diabetes x 1
CDE x 2
DE x 4
RN x 6
Dietitian x 2
Podiatrist x 1
Medical Student x 4
DE x 2
PN x 1
Pharmacist x 1
Medical student x 3
RN x 7
Doctors x 3
60
34
17
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Attachment G
Aboriginal Health GP x 1
Aboriginal Health Worker x 2
RN x 2
CDE x 1 6
Final Total 592
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Attachment H
Regional Education Series - Health Professional Feedback
Planned practice changes
What did you learn that will assist you when caring for people with diabetes?
> BGL monitoring.
> Hypo management.
> Medication management.
> There are also lots of contribution factors and things to watch out for.
> The correct times of doing BGL’s.
> Medications and their effects.
> Assessing diabetes on and for emergency care.
> The importance of a care plan.
> Different medications/side effects.
> People should have management plans.
> Having a good underpinning knowledge enhances patient care.
> Physiology of anatomy for diabetes.
> Times of glucose monitoring. Before meals most important. Needs to be individualised,
dependent on age (not just chronological age), medication, glucose levels.
> Different ways of explaining ‘medical’ terminology.
> Value in pre meal BGL as to post meal BGLs.
> Have a much clearer picture now on ketones in T1 & T2 diabetes.
> Management of ‘older’ person.
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Attachment I
Regional Education Series - Community Feedback
Planned behaviour changes
What did you learn today?
> To have a sick day box – good idea.
> Good idea – setting up a sick day lunch box.
> The information received, well done, excellent session.
> Knowing the tummy is the best place for my injection.
> That I get to spend every day with my grandson.
> The pleasant way the subjects were presented.
> Talk to other people with diabetes.
> The Government helping country people.
What will you do differently?
> Test my sugar at different times.
> Test at different times not just AM.
> Advise diabetes patients to have a sick day lunch box.
> Change my eating habits, lose weight.
> Make more time for family and friends.
> Blood glucose checks.
> Manage medicines better.
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Attachment J
Videoconferencing Series – 2010 Program
Wednesday
10 th February 2010
1.00 – 2.00pm
Diabetes self care program –
7 steps
Jane Giles and
Kate Visentin
Diabetes education
TQEH
Wednesday
10 th March 2010
1.00 – 2.00pm
How do my patients learn?
Pauline Hill
Senior lecturer
University of SA
Wednesday
14 th April 2010
1.00 – 2.00pm
Assessing suicidal thoughts
Dee Travis
Educator facilitator
FMC
Wednesday
12 th May 2010
1.00 – 2.00pm
Renal disease – stepping
through the stages
Dr Pat Phillips
Director Endocrinology
TQEH
Wednesday
9 th June 2010
1.00 – 2.00pm
Service barriers for
Aboriginal people with
diabetes
Sandy Wilson
Aboriginal health worker
Murray Bridge
Wednesday
14 th July 2010
10.30 – 11.30am
Stratifying foot education
based on risk
Sara Jones
Senior Podiatrist
University SA
RAH
Wednesday
11 th August 2010
10.30 – 11.30am
Type 1 diabetes and exercise
Dr Ian Chapman
Endocrinologist
RAH
Wednesday
8 th September 2010
1.00 – 2.00pm
Food for thought
Marc Campbell
Dietitian
TQEH
Wednesday
13th October 2010
1.00 – 2.00pm
DAFNE in a rural setting
Barbie Sawyer, CDE Mt
Gambier and Di Vine
CDE Naracoorte
Wednesday
10 th November 2010
1.00 – 2.00pm
Meeting the needs of
Adolescent with diabetes
Diana Sonnack
CNC Diabetes
RDNS
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Attachment K
Videoconferencing Series - Attendances
Attendances: 317
Session 1
Diabetes self care program – 7 steps
(Jane Giles and Kate Visentin Diabetes education TQEH)
Registered Nurses 12
Enrolled Nurses 2
Dietitians 4
Diabetes Educators 14
Podiatrist 0
Aboriginal Health 11
Session 2
Session 3
Session 4
Session 5
Session 6
How do my patients learn?
(Pauline Hill Senior lecturer University of SA)
Registered Nurses 8
Enrolled Nurses 0
Dietitians 5
Diabetes Educators 13
Podiatrist 0
Aboriginal Health 0
Other 0
Assessing suicidal thoughts
(Dee Travis Educator facilitator FMC)
Registered Nurses 7
Enrolled Nurses 1
Dietitians 1
Diabetes Educators 7
Podiatrist 0
Aboriginal Health 2
Other 2
Renal disease – stepping through the stages
(Dr Pat Phillips – Endocrinologist, TQEH)
Registered Nurses 8
Enrolled Nurses 1
Dietitians 4
Diabetes Educators 20
Podiatrist 0
Aboriginal Health 0
Other 2
Service barriers for Aboriginal people with diabetes
(Sandy Wilson Aboriginal health worker Murray Bridge)
Registered Nurses 3
Enrolled Nurses 0
Dietitians 6
Diabetes Educators 14
Podiatrist 1
Aboriginal Health 2
Other 2
Stratifying foot education based on risk
(Sara Jones Senior Podiatrist University SA RAH)
Registered Nurses 4
Enrolled Nurses 0
Dietitians 0
Diabetes Educators 18
Podiatrist 8
Aboriginal Health 0
Other 4
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Attachment K
Session 7
Type 1 diabetes and exercise
(Dr Ian Chapman Endocrinologist RAH)
Registered Nurses 1
Enrolled Nurses 0
Dietitians 2
Diabetes Educators 23
Podiatrist 0
Aboriginal Health 0
Other 0
Session 8
Food for thought
(Marc Campbell Dietitian TQEH)
Registered Nurses 8
Enrolled Nurses 0
Dietitians 5
Diabetes Educators 20
Podiatrist 0
Aboriginal Health 0
Other 1
Session 9
DAFNE in a rural setting
(Barbie Sawyer, CDE Mt Gambier and Di Vine CDE Naracoorte)
Registered Nurses 5
Enrolled Nurses 2
Dietitians 9
Diabetes Educators 26
Podiatrist 0
Aboriginal Health 0
Other 5
Session 10
Meeting the needs of Adolescence with diabetes
(Diana Sonnack CNC Diabetes RDNS)
Registered Nurses 5
Enrolled Nurses 0
Dietitians 2
Diabetes Educators 11
Podiatrist 0
Aboriginal Health 0
Other 0
Other
Social worker 1 Podiatry student 4
Nursing student 5 Ambulance officer 2
General practitioner 4
Registered Nurses = 64
Enrolled Nurses = 7
Dietitians = 38
Podiatrists = 10
Aboriginal Health Workers = 16
Diabetes Educators =166
Other = 16
_____
Total Participated 317
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Attachment L
Videoconferencing Series – 2011 Program
Wednesday 9 th February
1.00 – 2.00pm
Wednesday 9 th March
2.30 – 3.30 pm
Wednesday 13 th April
2.30 – 3.30pm
Wednesday 11 th May
1.00 – 2.00pm
Wednesday 8 th June
1.00 – 2.00pm
Wednesday 13 th July
11.30-12.30 pm
Wednesday 10 th August
1.00 – 2.00pm
Wednesday 14 th September
1.00 – 2.00pm
Wednesday 12 th October
1.00 – 2.00pm
Wednesday 9 th November
1.00 – 2.00pm
Heart Disease: What do
we look for?
Bariatric Surgery: Pre
and post care
Diabetic kidney disease
Country podiatry
services for people with
diabetes
Gestational diabetes
Update in pancreatic cell
transplant
Medications – where are
we now?
Acute complications
Inpatient management
Vitamin D: its link to
diabetes and other
health issues
Libby Birchmore
Nurse Practitioner
Nick Wray
Dietitian
Dr. David Jesudason
HOU QEH Diabetes Centre
Noami Zakarias
CHSA Lead Podiatrist
Dr Bill Jefferies
Head, Division of Medicine LMH
Toni Radford (Islet Transplant
Program Coordinator) and
A/Professor Toby Coates RAH
Dr Anthony Zimmermann
Staff physician, LMH
Dr Peak Mann Mah
Endocrinologist, LMH
Dr Elaine Pretorius
Medical Head of Diabetes and
Endocrine Services LMH
Mel Reid
Senior Dietitian
Southern Fleurieu Health Service
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Attachment M

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Attachment M

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Attachment M

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Attachment M

Attachment N
Diabetes Education Factsheets
Reviewed and updated
> Type 2 diabetes, Are you at risk
> Blood pressure and diabetes
> Kidneys and diabetes
> Oral health
> Eye care
> Long term management
> Smoking
> Your health care team
Developed
> Your care plan
> Footcare; High risk feet
> Footcare; Low risk feet
> What is type 1 diabetes
> What is type 2 diabetes
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Attachment O
CHSA Diabetes Education Network – Terms of Reference
Aim
To promote a collaborative, standardised and evidence based approach to diabetes education and support
across public and private health services in country SA.
Objectives
> To increase standardisation for diabetes education and care based on best practice.
> To increase consistency in diabetes education and management across country SA.
> To strengthen clinical leadership in the area of diabetes education and support.
> To increase professional support between specialist and generalist health professionals within both public
and private sectors eg diabetes resource nurses, practice nurses and Aboriginal health workers.
> To build capacity for diabetes education and management within the cluster.
> To strengthen a collaborative approach on appropriate state-wide projects.
> To act as an expert reference group for Country Health SA, service managers and others involved in
service planning.
Membership
> Diabetes Outreach
> Diabetes educators (can be an RN, practice nurse, CDE or other health professional as deemed
appropriate by the health cluster)
> Each health cluster has adequate representation based on need and as decided by group (most clusters
have 1-2 representatives)
Meetings
> Monthly
> Via telephone
> Face to face planning meeting once per year
Roles & Responsibilities
Diabetes Outreach
> Provide leadership to the network
> Assist with capacity building within the network
> Provide a communication link for the network with Country Health SA and Community Health Directors
> Write up and distribute minutes within 2 weeks of the meeting
> Write up and distribute agenda within one week of the meeting
> Arrange and coordinate a yearly planning meeting for the network
> Support all members with any projects that are part of the network
> Collaborate with members of the group when developing or updating diabetes resources
> Provide mentoring as required
Cluster representatives
> Represent the health cluster and bring key issues to meetings as required
> Promote consistency across cluster
> Ensure communication with key stakeholders across the cluster
> Disseminate minutes and/or executive summary to key contacts across the cluster
> Provide leadership across the cluster
> Provide mentoring as required
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Attachment O
> Participate in the critical review of key documents as required
> Contribute to strategic planning
> Advocate for country clients
> Actively participate in projects within the network
> Share resources and continuing professional development opportunities.
Chairperson
> Rotate with each meeting
Reporting
> Copy of minutes (or executive summary) to be forwarded to Community Health Manager/s or relevant
supervisor within each person’s health service.
> Send/email minutes/executive summary out to cluster via an email distribution list.
Endorsed by the group: July 2010 Review: July 2011
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References
1. SA Health, 2008, Strategy for planning country health services in SA, December, Government of South
Australia, Adelaide.
2. South Australian Aboriginal Health Partnership, 2005, Diabetes: A South Australian strategy for Aboriginal
and Torres Strait Islander people 2005-2010, South Australian Department of Health, Adelaide.
3. Australian Institute of Health and Welfare, 2006, Rural, regional and remote health - Mortality trends 1992-
2003, Australian Institute of Health and Welfare, Canberra.
4. Australian Institute of Health and Welfare, 2008, Diabetes: Australian facts 2008, Australian Institute of
Health and Welfare, Canberra.
5. Population Research and Outcomes Studies Unit, 2007, South Australian diabetes prevalence for those 16
years and over from 2002/03 to 2006/7, December, Government of South Australia, Adelaide.
6. Glover J, Ambrose S, Page A, and Tennant S, 2008, Atlas of potentially avoidable hospitalisations in South
Australia, Public Health Information Development Unit, Adelaide.
7. Population Research & Outcomes Studies Unit, 2006, Diabetes in rural and metropolitan areas, July,
Government of South Australia, Adelaide.
8. SA Health, 2008, South Australia: Our health and health services, SA Department of Health, Adelaide.
9. Australian Bureau of Statistics and Australian Institute of Health and Welfare, 2008, The health and welfare
of Australia's Aboriginal and Torres Strait Islander peoples, Commonwealth of Australia, Canberra.
10. National Diabetes Services Scheme, NDSS SA registrants: Type1 diabetes 0-18 yrs and 19-25 yrs.
2008, Diabetes Australia Ltd: Canberra.
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