Part 5: Making it easier to take part in the programme
Recording why people decline the free annual health check
5.1
In our Get Checked report, we recommended that DHBs record the reasons patients give for turning down the free annual health check. Having this information would allow DHBs to recognise any common barriers to people accessing that check and to take action to remove these barriers, if possible.
5.2
We recognise that people diagnosed with diabetes have the right to decide whether they take part in the programme. However, some people may not take part in the programme because of reasons outside of their control. For example, a patient may decline a free annual health check because they cannot easily attend an appointment during their GP’s normal opening hours because of work or family commitments.
5.3
In our 2009 survey, few DHBs provided us with information about whether GPs in their district were recording the reasons why patients declined to take part in the programme. One DHB told us that its PHO collects the general reasons for patients declining to take part in the programme.
5.4
Some DHBs reported that they carry out other activities to discover why people were not getting checked. These activities were often targeted at particular groups with low uptake of the programme, such as Māori and Pacific Island groups. For example, Canterbury DHB told us that it had contracted a market research company to survey patients diagnosed with diabetes. The survey’s aim was to examine the lack of uptake of programmes for primary care diabetes management, such as the Get Checked programme. Capital and Coast DHB told us that it supports an annual Pacific Diabetes Fono, during which issues about accessing diabetes care are discussed.
5.5
We support the use of these methods and consider that they may be effective and efficient in discovering why people are not taking part in the programme.
| Question to consider: |
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| 11. Are you working to identify why patients are not taking part in the Get Checked programme? |
Removing barriers for Māori and Pacific Island peoples to diabetes care
5.6
In our Get Checked report, we said that DHBs should have initiatives to remove barriers to Māori and Pacific Island peoples accessing diabetes care. It is important that Māori and Pacific Island peoples have access to diabetes care because they have significantly worse health outcomes than other people with diabetes.
5.7
In our 2009 survey, most DHBs told us that they had initiatives to reduce barriers to accessing diabetes care for their Māori and Pacific Island populations. They had different approaches to this, although several had a focus on providing diabetes care through services other than general practices. Figure 6 sets out some examples of DHBs’ initiatives to improve access to diabetes care for Māori and Pacific Island peoples.
Figure 6
Examples of initiatives to remove barriers for Māori and Pacific Island peoples diagnosed with diabetes
| Auckland DHB told us that it had adopted strategies to optimise access for high-needs groups (including Māori and Pacific Island peoples). These strategies included access to interpreting services in primary health care, increasing the capacity of general practices in high-needs areas with large Māori and Pacific populations to provide appointments outside of traditional opening hours, and providing courses on diabetes self-management. Bay of Plenty DHB reported that its transportation scheme for patients in a low socio-economic area of its district was proving very successful. Capital and Coast DHB told us that, among other initiatives, it had established Diabetes Nurse Educator roles to provide clinical and general-practice-based support for Māori and Pacific peoples to improve diabetes management. Nelson Marlborough DHB reported that both of its PHOs had established good links with Māori health providers and local marae for delivering diabetes services to Māori diagnosed with diabetes in an appropriate setting. In Marlborough, the Tane Ora conference and the Vascular Risk Assessment service (delivered through practices and community venues) have identified Māori with diabetes, or at risk of developing diabetes, and supported them to enter the care of a general practice. Kimi Hauora Wairau (Marlborough PHO) provides funding, training, and professional development for the nurses of two Māori health providers working in diabetes care, supporting the provision of diabetes care in a kaupapa Māori environment. Waikato DHB told us that it had given PHOs an incentive, through a local quality indicator programme, to target Māori and Pacific Island peoples to have an annual review. |
5.8
However, it is not always clear how effective these initiatives have been in removing barriers for Māori and Pacific Island peoples accessing diabetes care. We discuss the evaluation of such initiatives in paragraphs 5.15-5.18.
| Question to consider: |
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| 12. Do you have initiatives in place to remove barriers to diabetes care for Māori and Pacific Island peoples? |
Removing barriers for other groups to diabetes care
5.9
In our Get Checked report, we recommended that DHBs consider whether any other groups had trouble accessing the programme and create initiatives to improve access for those groups, if possible. In particular, we noted that some Asian ethnic groups had a high prevalence of diabetes.
5.10
In 2009, Auckland DHB told us that it had identified a need for additional support for the Asian ethnic group to access diabetes care. Auckland DHB reported that it had employed a diabetes nurse specialist since 2008 specifically to work with this ethnic group, and with providers with a high proportion of people from this ethnic group in their general practices. This DHB has the highest proportion of Asian people in its population. In our view, this is a positive step towards supporting this ethnic group to access diabetes care.
5.11
Some other DHBs reported that they did not have initiatives to support other population groups to access diabetes care. This was because they had high numbers of Māori and Pacific Island peoples or small numbers of other groups, or both. However, only one of these DHBs told us that it had information that the Asian community in its district was satisfactorily accessing primary health care. DHBs need to provide additional support to groups where there is evidence that these groups are not satisfactorily accessing diabetes care.
5.12
Some DHBs reported to us that they had identified other groups needing extra support to access annual checks, such as:
- those living in low income areas;
- refugees and migrants;
- children and adolescents;
- seasonal workers; and
- those living in rural areas.
5.13
Figure 7 sets out the groups some DHBs had identified and the support they reported having in place.
Figure 7
Other groups identified as needing support to access diabetes care and initiatives to support access
| Capital and Coast DHB reported that its other high-needs populations, including those in low income areas and refugees, are able to access some additional support. A high number of this population live in one of the targeted areas for the diabetes nurse specialists that is also provided with a PHO diabetes nurse. Hutt DHB reported that it has created specific services for children and adolescents with diabetes. It reported that "Paediatric clinics are clustered around age-banded cohorts with joint child and parent sessions run prior to Outpatient clinics, which increases practical day to day supports within this vulnerable group". It also had services to send text messages to adolescents. Its LDT had identified that the DHB needs to consider the needs of migrants and refugees in the future. Nelson Marlborough DHB reported that the needs of its other low-income populations are served by existing Māori health providers and, in rural areas, by the DHB’s rural services. In rural Marlborough, people receive care from satellite medical clinics in Havelock and Seddon. Eligible seasonal workers in Marlborough receive care from the range of general practices in Marlborough. |
5.14
Other DHBs should consider whether other groups within their district need additional support to access diabetes care.
| Question to consider: |
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| 13. Have you established whether groups other than Māori and Pacific Island peoples in your district are satisfactorily accessing diabetes care, and do you have arrangements to support access by these groups where it is needed? |
Evaluating and sharing successful initiatives to remove barriers to diabetes care
5.15
In our Get Checked report, we recommended that initiatives to help certain groups to access diabetes care be evaluated to test whether they are achieving their goal. Such evaluation would also identify any improvements that could be made to the programme. Without knowing how effective initiatives are, DHBs and PHOs may be wasting their resources.
5.16
Few DHBs reported to us in 2009 that they had measures to evaluate initiatives for removing barriers to accessing diabetes care. No DHBs provided detailed information on their work.
5.17
In our view, any initiatives evaluated as successful should be shared with other DHBs and PHOs to see whether they could be successful in other districts.
5.18
Some DHBs told us that they were sharing successful initiatives. Figure 8 sets out some examples of the ways DHBs reported sharing successful initiatives.
Figure 8
Examples of sharing successful initiatives for removing barriers to accessing diabetes care
| Auckland DHB reported that it had set up an information network and various forums where PHOs and other organisations can share their experiences and highlight what is working for them. Capital and Coast DHB told us that it supported discussion about existing initiatives at various forums within its district, including LDT meetings, the PHO Advisory Group, and the Primary/Secondary Clinical Governance Group. MidCentral DHB reported that it and its PHO had been sharing with other DHBs its successes with the programme and with the Diabetes Service Plan. |
| Question to consider: |
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| 14. Do you know whether initiatives you and your PHOs have to remove barriers to accessing diabetes care are effective, and are you sharing successful initiatives within your district and with other DHBs? |