DIABETES
EXECUTIVE SUMMARY
Diabetes has long been
recognised as a major cause of preventable morbidity and mortality in the community.
Within the literature, there is evidence of the effectiveness of medical intervention and
appropriate patient education on reducing the development of disease, and progression of
long-term complications, in diabetes. Provision of appropriate and accessible treatment
services is therefore known to be effective in reducing morbidity and mortality and the
consequent use of health care resources.
Current
thinking in health care focuses on improving health for the whole community and
specifically on improving the health outcomes or results of health care interventions and
health promotion programs. In 1993, a National Action Plan for the prevention and control
of non-insulin dependent diabetes mellitus (NIDDM) in Australia was developed in
conjunction with the Goals and Targets for Australia's Health in the Year 2000 and beyond.
The goals of the National Action Plan relate to the prevention and control of NIDDM and
its complications with a strong emphasis on the need for standardised data on diabetes and
its outcomes. This work is currently being progressed by Diabetes Australia through the
development of realistic and actionable Strategy Plans for 1995.
As part
of NSW Health Department initiatives, a prototype for applying the health outcomes
approach to planning and evaluating care for people with non-insulin dependent diabetes is
being developed. The aim is to ensure that services are effective and sufficiently
accessible to provide optimal outcomes for people with diabetes. Key questions to be
addressed within the health outcomes approach to diabetes relate to the effectiveness of
current interventions, identification of the best model of care and evaluation of the ways
in which access to services can be improved.
The
Local Context
Diabetes
is a significant health problem for the population of South Western Sydney Area Health
Service. A report on the epidemiological profile of the Western Metropolitan Health Region
produced by the Department of Health in 1986 identified diabetes, particularly in women,
as one of the leading causes of death in the area from 1979 to 1982. More recent
epidemiological data demonstrates this continued trend with the standardised mortality
ratios for diabetes in SWSAHS females being the highest in NSW for the period 1984-88.
Ratios for males were also high.
In
recognition of the importance of the problem, a review of diabetes services in SWSAHS was
undertaken in 1991 and a number of recommendations made in relation to the service
requirements and staffing levels within each Sector. A position of Area Adviser in
Diabetes was subsequently created. Although significant progress has been made in shifting
the focus of service delivery to being predominantly ambulatory-based care, the extent of
demand generated from such a diverse and rapidly expanding population continues to outpace
the level of available resources.
In order to achieve
significant future improvements in the health status for people with diabetes, SWSAHS has
identified the need to develop a comprehensive outcomes driven plan for the Area-wide
provision and enhancement of services for people with diabetes
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