Improving Diabetes Outcomes

The Western District Health Service (WDHS) Diabetes team together with Practice Nurses from Hamilton Medical Group (HMG) have developed improved processes to deliver enhanced care for clients with diabetes.  The Improving Diabetes Outcomes project has been based on the National Evidence Based Guidelines for the Management of Type 2 Diabetes and the Wagner Model for improving chronic care and aims to improve patient navigation through the often complex primary health care system.  The aims of the Improving Diabetes Outcomes project included

  • Integration of services to improve patient outcomes for those with diabetes
  • To develop and implement a diabetes service system based on the Wagner chronic care model for the Southern Grampians Shire
  • To enhance consumer navigation through the system
  • To build partnerships and collaborate between services to develop and implement an integrated diabetes care model

The Improving Diabetes Outcomes project has resulted in the production of the Southern Grampians Diabetes Pathway.  This document is based on Diabetes Australia publications: Diabetes Management in General Practice 2012/2013 and National Evidence Based Guidelines for the Management of Type 2 Diabetes.  The document aims to provide consistency of practice across the shire against the national guidelines and aims to promote a smoother journey for consumers with diabetes.  The document outlines goals for diabetes management, defines the diabetes team and provides visual pathways for recommended management of diabetes in Southern Grampians.  An adjunct to the pathway is the “Living with Diabetes in Southern Grampians” brochure for clients aiming to give people an overview of how to manage a diagnosis of diabetes and the services available in the shire.  The brochure also outlines the recommended cycle of care.