The role of the Diabetes outpatient clinics at BMDH and Westmead Hospital are changing.
Many of the patients with type 2 diabetes who have been reviewed every six months or annually have been discharged back to routine care by general practice. This is made possible by all the capacity building especially around HealthPathways and Case Conferencing for local GPs.
The more specialised management of more complex cases has remained especially for type 1 diabetes, gestational diabetes and patients with advanced renal, foot, vascular and cardiac disease. A special effort has been made to build the capacity of psychiatrist and mental health hospital based clinicians to better manage diabetes in the Mental Health clinics.
The Diabetes outpatient clinics have been adapted to become the Rapid Access and Stabilisation clinics for the Integrated Care demonstrator project.
The default now being that most patients in the type 2 complex management clinics would be enrolled in Integrated Care.
Patients now identified with poor diabetes control or just diagnosed with diabetes, are being followed-up on discharge in the clinic for a short time prior to discharge to GPs for ongoing care.
The diabetes clinics have expanded their multidisciplinary team to include more diabetes nurse educators, podiatrists, dieticians and in the future, psychologists and exercise physiologists. A team management approach to OPD management exists with receptionists, OPD nurses and the clinical team meeting regularly to make the experience work best for the patient, achieve the best clinical outcomes and work efficiently and cost-effectively.
A general practice support line promoted through case conferencing and the Integrated Care program is active and being used several times a week to avoid unnecessary admissions and continue to build general practices skills in diabetes management.