Overview
Diabetes Management Along the Mallee Track…Ouyen Victoria

The Mallee Track Health & Community Service (MTH&CS) Ouyen Victoria embarked upon a major Diabetes project to identify and track diabetes suffers and those at possible risk of Diabetes Type 2 factors across our region. The project was funded under the Dept Health & Ageing, Rural Chronic Disease Initiative (RCDI) program to deal with Diabetes across the Mallee Track. The Mallee Track is located 5hours north west of Melbourne and one hour south of Mildura, with a local district population of 2,900. One of our centres is a one-hour drive west being the furthest Victorian town from Melbourne.

Diabetes is one of the Top 10 health problems for people of all ages in the Mallee Region based on Victorian Burden of Disease data as well as highlighted in the top ten National Health Priorities for Australians. In Australia it is a hidden epidemic with research revealing that more than a million people have diabetes with over half being undiagnosed.

The "Diabetes Management Along the Mallee Track" program of the Special Community Health Projects Team, headed by Bernard Denner is responsible for a range of early intervention integrated health programs across the Mallee Track Community Health Service.

The Team worked closely with local GPs at the Mallee Track Medical Centre (and externally with Dr Irina Kudriavceva at Manangatang Surgery), MTH&CS Allied Health and Community Health Nurses in developing better diabetes management outcomes for our project participants. The Project partnership with Mallee Division of General Practice (MDGP) also provided resources, staff education and a dedicated Diabetes Educator, Lynnette Flavel once a month at the Ouyen Centre.

An Advisory Committee with local community representation from the Community Diabetes Support Group President, Mrs Pauleen Harrison, supported the direction of the program.

The appointment of the Community Point of Care Unit at Flinders University South Australia headed by Medical Scientist; Mr Mark Shephard supported the project with new technology for tracking and assessment for diabetes and maintenance of diabetics in the community plus data collection, evaluation and professional development training for a range of staff. This partnership will continue beyond the life of the project. The partnership provided the program and staff with significant new skills and learning strategy for future outcomes.

Brief program overview …Commenced in March 2003 and completed in March 04

Project Objective: Improved planning and coordinated care across our region for existing Diabetics clients and those in the general community potentially at risk of Type 2 Diabetes with emphasis on self-management, staff training, resources and community education.

Project Strategy: Firstly to provide diagnosed Diabetics with an Integrated Health Service program that supported a Multidisciplinary approach to Diabetes management

Secondly to provide an Early Intervention Risk assessment strategy in a settings approach for the general community across the Mallee Track using the latest point of care technology to assist with the identification of risk factors to diabetes.

These strategies used a range of interventions to achieve the project objective;

• Multidisciplinary approach through a GP Practice based program with MTH&CS staff and Diabetes Educator providing an integrated model of care for the maintenance of diabetes.
• Education and training for a range of Community Health Nurses and staff to support this integrated approach across the Mallee Track region.
• Development of resources and processes to provide a pathway for diabetics to better health maintenance within a remote rural area. (See attachments)
• Further development of new point of care technology that supported Diabetics and Community participants through trained staff enabling participants to access results and the presence of risk factors that would impact on their condition. This process allowed the GPs, Diabetes Educator and Community Health Nurses to give advice and support to clients based on the data without delay or further travel. (see participants program evaluation)
• The appointment of Community Point of Care Unit, Flinders University South Australia, guaranteed our program with compliance to Quality Assurance (QA) for our risk assessment sessions. Flinders provided a program of professional development for staff around diabetes and the use of technology and 'tracking' clients to support their maintenance program. Beyond the project we will continue to use Flinders to provide a QA service as well as a workshop around the outcomes and findings of the project for both Health Professionals and Diabetics. The Flinders University report provides Qualitative and Quantitative research that demonstrates the value early intervention and an integrated approach to health outcomes. Participants clearly reported through the MTH&CS evaluation process of feeling better and having a new confidence in dealing with their condition.
• The project also integrated into existing MTH&CS programs and supported a major community exercise strategy called 'Walk Australia'. This project has attracted over 250 participants across Mallee Track representing over 15% of the population. Two other programs included 'Tennis for Blokes' attracting over 27 participants and another targeting older participants with an exercise and wellbeing program called 'Your Choice Good Health'
• To further support a better outcome, a Settings Approach (members of Country Fire Authority (CFA), Local School Teachers, Diabetics at GP Practice) strategy has allowed us to track and effectively support Behavioural Changes (Reducing risk based on actions taken by participant) for clients based on risk assessment screening results and a program that provided access to our services three times over the 12months project period.
• The project and the MTH&CS also supported the training of a Diabetes Educator from the nursing staff at the hospital therefore guaranteeing a sustainable and long-term commitment to providing a service to local Diabetics. In the past this has been only an Outreach Service based around funding when available. Diabetic clients now do not have to travel up to two hours or more to access Diabetes Educator services.

Project Outcome in Brief for Diabetics

• Forty (49) Diabetics attended GP Practice and MTH&CS intergrated sessions coordinated care by 2/3 sessions
• Six (6) nurses completed training and professional development sessions conducted by Flinders University
• One nurse completed a Diabetes Educator course in Melbourne
• Diabetes Educator conducted ten (10) Diabetic sessions and two (2) staff education sessions
• Resources were developed across a range of applications to support Diabetes Education and risk assessment
• Our new technology was further developed and staff further skilled in its operation
• Integrated programs were developed within Health Service to support more sustainable outcomes for participants
• The program was conducted in another remote location at Manangatang in support of their local GP with twenty-two (22) participants. This will continue every 3 months in support of their Diabetics. This demonstrated how Adoptable and Adaptable the program is in another area.
• Meetings were conducted with Diabetes Support group and will continue with workshops in the future.

Project Outcome in Brief for Community

• Three hundred and forty five (323) community participants attended risk assessment screening with over 150 attending multiple sessions.
• Community Health Programs developed in partnership with RCDI Project to support the reduction of risk factors across our communities for cardiovascular disease and diabetes.

1.Walk Australia…250 participants have 'hoofed up over 65,100 kilometres in 12months

Respondent's main reasons for registering with the Program:

Increase fitness levels 80%
Improve general health 93%
A good reason to walk 52%
To get them exercising 48%
A form of alternative exercise 33%
For the enjoyment / company 28%


Since commencing the program, respondents have noticed a change in:

Fitness 94%
Eating Habits 43%
General Health 83%
Socialising 43%
Lower Stress 52%
Sleep Patterns 37%
Weight 44%

Respondents found the best part of the program were:

Exercise 87%
Impact on health 64%
Weight loss 26%
Socialising 22%
Prizes as incentives 22%
The fun of competition 19%
Lower Stress 13%
Networking 2%

43% of the respondents had attended a Health Screening
59% of the respondents will attend a Health Screening

2.Tennis for Blokes… into its 2nd season with 27 players attending mid week tennis tournament - a first for the community.

57% of the respondents rated the activity as Excellent
76% of the respondents rated the Mid Week Tennis as Excellent

100% of the respondents said that in general the tennis for blokes was good for them.

Why:
Good fun
Got me out during the week
It is fun
Like drinking while exercising
Socializing with other members of community
Good socially and to unwind
Good time of day to play - not too hot
Can't play weekends
Activity/Social/Away from work hassles
Lots of new faces
Social
Time out, rest, unwind from work
Get away from wife
Release from work with fitness
Sociable, relaxing
Socializing
Blokes from all over and socially

62% of the respondents found the risk assessment screening worthwhile
Why:
I was A OK
Eye opener
Gives a good idea how you're travelling
It made me feel at east with my health
To see how my cholesterol was
Never done one before

3 Community - Risk Assessment Screening for Cardiovascular Disease & Diabetes risk… Blood Pressure, Blood Sugar and Cholesterol levels.

A settings approach was adopted based on the success of our risk assessment-screening program over last 3years. This Best Practice program is developed to provide through multiple sessions the opportunity to track participants for risk factors and with education and GP interventions support behaviour change and reduction of risk.

Comparisons of the settings approach with CFA and Diabetics streams.

CFA Final Evaluation Response…participants in most cases are not presenting to a GP
Awareness
91% of the respondents felt that the health screening sessions had provided them with a greater awareness of their health and their risks for diabetes

Reduction
17% of the respondents indicated that they have given up or reduced smoking
26.5% of the respondents indicated that they have given up or reduced their alcohol intake
49.5% of the respondents indicated that they have given up or reduced their fat intake
46.5% of the respondents indicated that they have given up or reduced their fast food intake

Lifestyle
65.5% of the respondents indicated that they shop for food items differently
71.5% of the respondents indicated that they now make healthy food choices
59.5% of the respondents indicated that they have increased their exercise levels or exercise differently
16.5% of the respondents indicated that they have joined the Walk Australia Program

65.5% of the respondents indicated that the screening program has had an impact on their General Health
39% of the respondents indicated that the screening program has had an impact on their Workplace Stress
45% of the respondents indicated that the screening program has had an impact on their Fitness Levels
39% of the respondents indicated that the screening program has had an impact on their Diabetes management
56.5% of the respondents indicated that the screening program has had an impact on their Diet and Food choices
62% of the respondents indicated that the screening program has had an impact on their approach to their health
45% of the respondents indicated that the screening program has had an impact on their approach to their GP

85.5% of the respondents felt that this program would benefit their health if conducted at least twice a year

Diabetics Final Evaluation Response…these respondents are diagnosed Diabetics

Awareness
73% of the respondents felt that the health screening sessions had provided them with a greater awareness of their health and their risks for diabetes

Diabetes Educator (DE)
68% visited a Diabetes Educator as a result of the program
68% indicated that the DE was responsive
68% indicated that they found their appointment with the DE valuable
64% indicated that their appointment assisted them with their diabetes management

Podiatrist
77% indicated that the Podiatrist was responsive
50% indicated that their appointment assisted them with their diabetes management

Reduction
23% of the respondents indicated that they have given up or reduced smoking
27% of the respondents indicated that they have given up or reduced their alcohol intake
82% of the respondents indicated that they have given up or reduced their fat intake
73% of the respondents indicated that they have given up or reduced their fast food intake

Lifestyle
68% of the respondents indicated that they shop for food items differently
82% of the respondents indicated that they now make healthy food choices
27% of the respondents indicated that they have increased their exercise levels or exercise differently
18% of the respondents indicated that they have joined the Walk Australia Program

55% of the respondents indicated that the screening program has had an impact on their General Health
36% of the respondents indicated that the screening program has had an impact on their Fitness Levels
55% of the respondents indicated that the screening program has had an impact on their Diabetes management
64% of the respondents indicated that the screening program has had an impact on their Diet and Food choices
59% of the respondents indicated that the screening program has had an impact on their approach to their health
59% of the respondents indicated that the screening program has had an impact on their approach to their GP

77% of the respondents felt that this program would benefit their health if conducted at least twice a year

These results clearly indicate the value of our strategy in the community settings approach. This has been repeated with our Walk Australia and our Secondary School Teachers screening sessions. We have recently extended the program to our veterans' community. The project over the 12months across all associated programs collected 707 questionnaires providing data that will support our future directions in quality health promotion and our early intervention strategies.

'Diabetes Management Along the Mallee Track' has provided the MTH&CS with an opportunity to further develop our skills and an Integrated Program that will now become part of the 'Culture' of coordinated care and protocols of the MTH&CS and the local GP Practice.

It will provide both Diabetics and the general community with the best possible outcome for Diabetes & CVD in a remote rural area based on the further development of new technology, resources, staff training, access to quality best practice support and protocols, an integrated coordinated care with local GPs and a partnership with the local Diabetes Support group for this chronic disease.

A full Project Report & Flinders University Program Analysis Report and
Resources & Program development and a CD Rom developed by Monash University on behalf of Dept Health & Ageing RCDI Program is available by contacting

Bernard Denner Projects Manager
MTH&CS Ouyen Vic
PO Box 130 Ouyen Victoria Australia 3490
(613) 50 92 1111 or fax 50 92 1177 or ( 61) 0419 566 750
Email bdenner@mthcs.vic.gov.au or bernard@mannet.com.au