cdmNet can help improve clinical outcomes in diabetes care
The clinical outcomes of patients with diabetes can be significantly improved by using general practice management plans and team care arrangements underpinned by web-based shared care management systems, a study has shown.
The study, published in today's Medical Journal of Australia, looked at the the management of 577 people with types 1 and 2 diabetes over 14 months, before and after the introduction of Precedence Health Care's cdmNet system to help manage their care.
cdmNet is a web-based technology that enables team-based care, allowing GPs to create care plans best suited to the patient's needs. Specialists, allied health professionals, pharmacists and the patient themselves can access the patient's health record and care plan.
It is being used in the federal government's Diabetes Care Project (DCP), which is assessing the use of technology, care facilitators and flexible funding models to improve care for people with diabetes. The DCP is the largest ever diabetes trial in Australia, with over 6500 active patients, 650 participating GPs and practice nurses and over 800 allied health professionals.
The benefits of care plans and the cdmNet system for chronic disease management were for many years championed by the late Jon Hilton, Precedence Health Care's program manager for cdmNet, who passed away late last month.
In the Monash University-led study, which was co-authored by Precedence Health Care's founder and CEO, Michael Georgeff, and its clinical integration lead Marienne Hibbert, significant improvements were seen in the quality of care and clinical outcomes for patients whose care was supported by cdmNet.
The main improvements came from a boost in regular reviews of GPMPs and TCAs, with 80 per cent of patients on a care plan created and managed using cdmNet regularly reviewed and followed up compared with national figures that indicate that less than 20 per cent of patients's plans are regularly followed up.
It also showed that for those patients who received regular reviews, 85 per cent adhered to best practice care, compared to 59 per cent otherwise.
The authors say that one explanation for this improvement is that placing patients on a GPMP or TCA helps the GP implement best practice guidelines and encourages the patient to adhere to these. cdmNet also reminds patients to make and attend appointments.
Clinical outcomes were also improved, with a statistically significant improvement in overall levels of measurements such as blood glucose and cholesterol levels. The greatest improvements were in patients who had regular reviews of their care plan.
Measurements of quality of care and clinical outcomes were based on the diabetes annual cycle of care (ACOC).
Professor Georgeff said in a statement that the study suggests that improvement in clinical outcomes is related to the level of coordination among the care team and with the patient. It also indicates that patients are more likely to adhere to their plan when it is regularly reviewed and followed up by the GP and the care team.
“How to put this into practice is the challenge,” Professor Georgeff said. “GPs’ waiting rooms are full of people with a chronic illness. Trying to keep track of what everyone is doing or not doing places a huge burden on GPs and practices, especially when communications among the team are limited to fax, telephone tag, and hand delivery of patient information.
“Without the use of advanced internet and mobile technologies, one simply cannot achieve the level of coordination and follow up needed for these patients.”
One GP who has been using cdmNet for several years is Tim Denton, a GP from Anglesea in Victoria who is also chair of the Barwon Medicare Local. "Since using cdmNet for ensuring quality of care, we have not had any amputations, strokes or progressive retinopathy in our patients with diabetes,” Dr Denton said.
Paul Zimmet, director emeritus at the Baker IDI Heart and Diabetes Institute and adjunct professor at Monash University, said the medium to long-term answer for type 2 diabetes was prevention. “But, in the meantime, to reduce the burden of this epidemic, people with diabetes require comprehensive support and care from a whole range of allied health professionals along with GPs and specialists,” Professor Zimmet said.
“It is a unique healthcare challenge and its treatment is best administered through a management plan involving a complete care team.
“Web‐based tools appear to enable this kind of care more easily and, as the Monash study indicates, clinical outcomes are worthwhile and likely to reduce the burden of the sometimes devastating complications of diabetes.”
Posted in Australian eHealth