Ministry of Health and district health boards: Effectiveness of the "Get Checked" diabetes programme

Performance audits from 2007: Follow-up report.

The “Get Checked” programme (the programme) was set up in June 2000 by the Health Funding Authority (HFA). The programme gives people diagnosed with diabetes the opportunity to get free annual health checks. These checks ensure that key tests (which assist in identifying diabetes complications early) have been completed for the year and treatment can be planned for the year ahead. The data collected from the programme is also important for providing care and for planning diabetes services.

District health boards (DHBs) are responsible for the programme and ensuring that it is delivered in their districts.

The scope of our audit

We carried out a performance audit to assess how well the programme achieved its objectives. Our audit sampled six DHBs - Auckland, Counties Manukau, Tairawhiti, Hawke’s Bay, Capital and Coast Health, and Otago - and selected primary health organisations (PHOs) within these DHBs.

This sample enabled us to look at districts where the programme was operating well and others where the programme was not working so well; and to highlight districts with large populations of Māori and Pacific Island people (who are particularly at risk of developing diabetes).

Our findings

We were pleased to find that the Get Checked programme had resulted in improved delivery and access to diabetes services. More people were getting these services, and there was heightened diabetes awareness and improved patient monitoring at the primary health care level. Education and guidelines for treatment and referrals to specialist diabetes services had improved. Innovative programmes were being used to remove barriers for those needing diabetes care, particularly Māori and Pacific Island peoples.

Of our 18 recommendations, five were aimed at DHBs and were about improving programme data quality. The remaining 13 recommendations suggested improvements to the programme’s effectiveness. These recommendations were directed at the Ministry of Health (the Ministry) or DHBs, and through them, PHOs and Local Diabetes Teams1 (LDTs). Five recommendations were directed specifically at the Ministry.

The response to our findings and recommendations

We recommended that the Ministry review and update (if necessary) the national referral guidelines for diabetes. A review is expected to be complete by mid-2009. The Ministry has also updated its Assessment and Management Handbook for Cardiovascular Risk, which is due to be published in early 2009.

We recommended that the Ministry and DHBs review the role of LDTs to decide how LDTs can best advise on the effectiveness of diabetes healthcare. The Ministry has reviewed the LDT service specification and identified some issues. An updated service specification is due to be ratified and put in place in early 2009.

We recommended that the Ministry and DHBs consider how to improve the adoption of our recommendations about LDTs. In its updated service specification each LDT is now required to report to the Ministry and the DHB (at least annually, sometimes quarterly) on diabetes services in their area. Also, the new service specification is more detailed about how DHBs must respond to LDT reports - for example, LDT reports must be tabled at DHB board meetings and the board must give feedback to LDTs on their reports.

We recommended that the Ministry and DHBs work with PHOs to evaluate existing initiatives designed to remove barriers to those needing diabetes care, and to make sure that all DHBs and PHOs are aware of any successful initiatives. The Ministry’s responses include:

  • “systems dynamic modelling” - a project between the Ministry, DHBs, PHOs, and the wider health sector to better understand the most important factors influencing health outcomes for diabetes and cardiovascular disease;
  • strengthened requirements for DHBs to document diabetes initiatives in their Annual Plans; and
  • using the Ministry’s Long-Term Conditions Programme (established in mid-2007) to share information and promote initiatives throughout the sector.

We recommended that DHBs and the Ministry further analyse (by, for example, cohort analysis) how well the Get Checked programme has influenced diabetes care and management, and to identify any further improvements. A cohort study commissioned by the Health Research Council is under way, and the Ministry is awaiting the results. The 2006/07 New Zealand Health Survey also contained questions about diabetes, and the results are expected to help validate the Get Checked programme’s data.

We intend to follow up during 2009 on the response to our remaining recommendations, which were directed at all 21 DHBs, and through them, PHOs and LDTs.

1: Local Diabetes Teams include includes clinicians and consumers. The Teams provide advice to district health boards, healthcare providers, and consumer support agencies on the effectiveness of services for people with diabetes within the district health board area.

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