smoothly but some people don’t have quite the same understanding of the long-term complications.� “The services at PNML are invaluable because they reinforce that message.� “The other aspect is that not only are the Medicare Local support services directed at newly diagnosed diabetic patients but also to people requiring ongoing management. Once you’re linked into the system there’s regular follow-up.� Dr Keith Ananda sees a distinct advantage in the centralisation of services at PNML, not least for the patient’s hip-pocket. “The fact that both the diabetes educator and the dietician are co-located is important. It’s easier to get a comprehensive summary sent to our practice and on to the patient. It’s exceedingly rare that there’s a breakdown in communication. And the fact these services are free is a bonus. That translates to a costsaving for the patient who would otherwise have to use more expensive options on a personal care plan.�
Budget changes loom The Medicare Local model will change after the current federal budget, which has Keith concerned. “There would be huge implications for patients if they lost support from allied health professionals in their own community. In essence, there would be added out-ofpocket expenses and that may well affect compliance levels. North Metropolitan, and others like it, is part of the process of establishing a comprehensive plan for patients with chronic diseases. It’s important they’re well-funded by government to ensure that care plans, regular reviews and referrals are done in a systematic and formal manner.� While Keith freely acknowledges the busy schedule of most GPs, he’s a firm believer in grabbing every chance to spread the word. “The core message is prevention because the long-term complications are serious
and costly. These days, despite the time pressures on a GP, you really have to focus on opportunistic screening. If a mother comes in with a couple of overweight children I’ll make the most of that opportunity to have a chat about diet.�
Ms Felicity Willis is the accredited dietician at PNML and sees her role as supporting the GP and empowering people to self-manage their diabetes.
are triaged according to their needs and advice from their GP. We run a series of group sessions. The first is an introduction with input from the dietician and the physiotherapist and the second covers complications, medications and advice from a podiatrist.� “Everyone in my family has diabetes so I guess it might be heading my way sometime.�
“We have the luxury of spending time with people such as Chris at a baseline appointment and then at three, six and 12 months. And, if needed, I see them more frequently than that. These services are free.�
Despite that, the future may not be unduly bleak. Some important research is being done including a study at Fremantle Hospital into pre-diabetic men and testosterone levels, says Teresa. And Chris’s case is both satisfying and rewarding.
Medicare Locals are designed to be part of the fabric of community medicine and Felicity is hopeful for their future, at least in the short-term.
“When you see good outcomes it makes it all worthwhile. The Medicare Local model makes it a lot easier for people to manage their diabetes.�O
“There have been comments about funding cuts in the recent budget. I’m under the impression that we’re safe until 2016. That’s important because primary health care in this context is playing a major role in addressing diseases like diabetes.�
By Mr Peter McClelland
DIABETES SERVICES
“Speaking about Chris specifically, the parameters his GP gave us indicated obesity was an issue and both the Diabetes Educator and I spoke about that at the first appointment. We’ve seen a vast improvement with Chris but for others it’s not quite so rapid. Nonetheless, they’re being educated about the condition and hopefully that will give them some goals to improve their selfmanagement.� “A lot of the same doctors refer to the program, but we have a large catchment area [see right] and I’m not sure all GPs are fully aware of what we can do to help.�
Ms Teresa DiFranco the PNML Diabetes Educator/Pharmacist reiterates the importance of a coordinated approach and acknowledges a personal dimension to this increasingly pervasive disease.
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