National Prevention of Type 2 Diabetes Program Overview

1. National Prevention of Type 2 Diabetes Program Overview Sabrina Ostowari Program Coordinator – Chronic Disease

2. General Practice 111 Divisionsof General Practice National Divisions Network • General Practice Queensland • Established 1997 • State-based organisation • Funded by Australian Govt. Department Health & Ageing • Role: • Build the capacity of Divisions • Leadership, advocacy and representation • Support, information and resources • Communication channel for stakeholders, e.g. QH • Collaborate with other state-wide bodies/organisations 8 SBOs

3. Background to the Prevention of Type 2 Diabetes Program • Initiative of the Council of Australian Government (COAG) • Part of the National Reform Agenda • Funding allocated for federal and state government strategies • Planning and implementation have has begun in all areas

4. Commonwealth Government Commitment • $103.4M to: • Develop an Australian Type 2 Diabetes Risk Assessment Tool (AUSDRISK) • New health assessment to undertake a type 2 diabetes risk evaluation for 40 – 49y • High risk patients can be referred by GP to subsidised accredited LMP • Develop National LMP Standards for accreditation and a system for accreditation • Fund Divisions Network to support delivery of the program at a local level

5. AUSDRISK Patients must be identified at ‘high risk’ (score of 12+) by this tool to be eligible for a referral to a subsidised accredited lifestyle modification program

6. Referral to Subsidised Lifestyle Modification Program through Medicare Items: • Eligible patients (i.e. 40-49 yrs for general population or 15-54 yrs for Aboriginal Torres Strait Islanders and identified at high risk of diabetes, score of 12 or more) can be referred through one of the following: • Item 701: Brief Health Assessment of less than 30 mins • Item 703: Standard Health Assessment lasting 30 to less than 45mins • Item 705: Long Health Assessment lasting 45 to less than 59mins • Item 707: Prolonged Health Assessment 60 or more • Item 715: Aboriginal and Torres Strait Islander peoples health assessment

7. Health Assessments • GPs will be required to undertake one of the following health assessments under one of the new time-based items to refer eligible patients to a subsidised accredited LMP: • a 45-year old health assessment • a type 2 diabetes risk evaluation • Aboriginal and Torres Strait Islander Adult Health Assessment

8. Aim: Review the factors underlying the 'high risk' score identified by the AUSDRISK to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes Patient Eligibility: 40-49 years of age At “high risk” of diabetes as defined by the AUSDRISK (score 12+) Not likely to have already developed diabetes Has not had an item 717* claimed in the past 3 years (only eligible once every 3 years) Type 2 Diabetes Risk Evaluation

9. Type 2 Diabetes Risk Evaluation and Health Assessments • Role of Practice Nurse, Aboriginal Health Worker and other Health Professionals to support GPs: • Identification of eligible patients • Patient information and collection • Provide patients with information

10. Relationship Between MBS Items

12. Strong Evidence for Lifestyle Modification Programs (LMP) • Clinical Trials - strong evidence that lifestyle modification can prevent or delay the onset of type 2 diabetes. • RCTs in the US and Finland - reductions in the incidence of type 2 diabetes of 58% over 3 years in people with impaired glucose tolerance • Government has provided funding for patients to attend subsidised accredited LMP

13. National LMP Standards • National LMP standards have been developed - University of Sydney Institute of Obesity, Nutrition and Exercise • Minimum guidelines for the content and delivery of an LMP to reduce risk of type 2 diabetes • Accreditation of LMPs are based on these standards

14. Content of an accredited LMP • Minimum Requirements • Risks of diabetes and the relationship to lifestyle risk factors • Importance of regular diabetes screening • Nutrition advice and education • Physical activity advice • Behavioral strategies to support the adoption and maintenance of lifestyle change • Smoking cessation and alcohol reduction advice if required • Information about community resources relevant to sustaining lifestyle change

15. What will an accredited LMP looks like? • Minimum Requirements • Face to face delivery • Individual or group sessions with groups no larger than 15 participants • Minimum of 8 hours of contact time • Initial intensive phase of at least 4 months duration • End program follow up session at least 6 months after commencement of the program (i.e. follow-up session at lease 2 months after completion of intensive phase) • Providers must be able to illustrate their ability to meet core competencies outlined in program standards

16. Accreditation • Accreditation ensures that LMPs meet the National LMP Standards • Only accredited LMPs will be able to claim a rebate for service delivery • A national accreditation system has been operational since 1 October 2008 • Australian Government Department of Health and Ageing has been managing the accreditation of LMP providers • Due to the significant number of already accredited programs available nationally, the accreditation system is currently on hold until further notice

17. National LMP Service Directory • Established and managed by AGPN • Hosted on AGPN website (www.agpn.com.au) • As new LMP providers become register, AGPN will update the National Service Directory • Info regarding qualifications and experience required to be included on service directory • Contact for National LMP Service Directory • Jane Bacot-Kilpatrick • AGPN • Phone: 02 6228 0845 • Email: jbacot-kilpatrick@agpn.com.au

18. Patient Subsidy • For all eligible patients enrolled in an accredited LMP, the provider will be able to claim a subsidy • The payment will be made as follows: • $77 (inc. GST) on patient enrolment • $121 (inc. GST) on completion of the intensive phase • $46.20 (inc. GST) on program completion • Maximum of $50 patient co-contribution (which is waived for pensioner concession/health care card holders) • GPQ pays the provider the patient subsidy • To receive payment, providers need to submit the required forms with an invoice to GPQ for payment

19. Centralised Subsidy Payment System • GPQ manages all payments of subsidies to all accredited LMP providers • LMP providers will be required to provide a copy of the client data form along with an invoice • Forms received will be cross checked and GPQ will enter data onto an online database system • GPQ will follow-up with LMP provider if data or information is missing/incorrect • Once all information is confirmed, GPQ processes invoice

21. GP Referral Form

23. End Program Feedback Form

25. What should the invoice include? • payment amount attached to each completion point of the program (i.e. enrolment, intensive phase and end program). • include GST (Business ABN must be GST registered) • include the name of the patient/s, as well as the Division in which the GP referral was made • submitted with a copy of the respective LMP form so GPQ to enter patient information in the minimum data set • an ABN and payment details (i.e. bank account) which are linked

27. National Level Evaluation • Why? • Patient health outcomes and satisfaction • Program implementation and modification required • Performance of individual LMPs to support quality improvement • Review state and local level outcomes • How? • Enrolment-mid-end point data • GP referral forms/LMP feedback forms • Online MDS Data Capture System • SBO and Division Reports • # Enrolments, program participation

28. Flow of Information and Support GPQ: payments of subsidies to LMP Providers Accredited LMP Providers Providers: tax invoices and data collection forms to GPQ Divisionsof General Practice Marketing and promotion General Practice

29. Divisions Network Roles and Responsibilities • AGPN • National management, co-ordination and support • Sub-contract GPQ • Sub-contract development of on-line MDS data capture system • Development of education and training resources and support tools • Coordination of the National SBO Network • AGPN website and Service Directory maintenance • Liaison with key stakeholders

30. General Practice Queensland • State level management, coordination and support including: • Centralised Administration System: Implementing and ongoing system for subsidy payments to LMP providers • Statewide Program Coordination: Working closely with Divisions to administer Program at local level • Networking and info sharing: Coordinating statewide meetings/ workshops/ teleconferences • Communication strategy: Establishing a state-wide network for the Program and implement a communication strategy with Divisions and Providers • Collate Division Data: Provide to Divisions to report on local activity and progress

31. General Practice Queensland • Resources Development/Dissemination: Disseminate (and develop where necessary) resources and tools for Divisions, general practices and LMP providers • Management of MDS Online System data: Ensure accurate, appropriate and timely entry of data (once established) • Support engagement of LMP providers: Provide support to Divisions to engage local providers of accredited LMPs to support access for eligible patients. • Coordination of a Steering Committee: to provide support, input and advice to GPQ regarding the implementation of the program • Evaluation: State level evaluation

32. Steering Committee • Aim: Provide support, input and advice to GPQ regarding the implementation of the program on behalf of the QLD Divisions Network • Representatives: Division CEO/EO or Management, LMP Provider Representation, GP Representation • Example Roles of Steering Committee: • Implementation options • Rural solutions • Marketing and Promotion • Evaluation • Demand management • Meetings: Bi-monthly

33. Roles of the Divisions Network • Divisions • Training and support for general practice and LMP providers • Community Awareness and Promotion • Promote and Support LMP Accreditation • Support Accredited LMP Providers or Provide LMPs • Supporting general practice to make appropriate referrals to local LMPs (i.e. support uptake of LMPs and GP referrals)

34. Accredited LMP Providers • Delivering LMPs in accordance with the program standards and accreditation requirements • Promotion and Marketing of LMP program • Collecting patient data and providing this to the GPQ in a timely manner using standard templates/forms • Submitting invoices to GPQ for payment • Liaising with local divisions

35. Thank you