Diabetes is a major health issue for New Zealand. Reducing the incidence and effect of diabetes is one of the Government’s population health priorities. Diabetes is also one of eight priority areas for improving Māori health.
The “Get Checked” programme (the programme) was set up in June 2000 by the Health Funding Authority to help people who have been diagnosed with diabetes better manage their condition and lower the risks of complications. DHBs are responsible for the programme and ensuring that it is delivered in their districts.
The programme entitles people who have been diagnosed with type 1 or type 2 diabetes to have a free annual health check from their general practitioner (GP) or appropriately trained registered primary healthcare nurse (diabetes nurse), who are usually members of primary health organisations (PHOs). The purpose of the check is to ensure that key tests (which assist in identifying diabetes complications early) have been completed for the year and to allow people to plan treatment for the year ahead.
The programme is part of the strategic direction for diabetes care set by the Ministry of Health (the Ministry) in 1997.
The programme’s objectives are to:
- systematically screen for the risk factors and complications of diabetes to promote early detection and intervention;
- agree on an updated treatment plan for each person with diabetes;
- prescribe treatment and refer people for specialist or other care if appropriate;
- update the information in the diabetes register, which is used as a basis of clinical audit and for planning diabetes services in the area;
- improve the planning and co-ordination of services delivered by all healthcare providers; and
- decrease the barriers to accessing high quality care for Māori and Pacific Island peoples.
We carried out a performance audit to assess the effectiveness of the programme. We assessed the extent to which the programme’s objectives were being met in a sample of six district health boards (DHBs) – Auckland, Counties Manukau, Tairawhiti, Hawke’s Bay, Capital & Coast Health, and Otago – and a selection of PHOs within these DHBs.
The DHBs had funding arrangements with various organisations to administer the programme (referred to as programme administrators in this report). The majority of programme administrators in our sample were PHOs, but they also included a community organisation, an independent practitioners association, and a DHB.
Programme administrators collect data from GPs, enter it in a database (the diabetes register), analyse the data, and report the results to GPs. They also arrange for DHBs to pay GPs, provide GPs with resources for carrying out the annual check, and provide a summary of the data to local diabetes teams (LDTs) and the Ministry of Health.
Five of the DHBs that we visited had an LDT that provided advice to the DHB on the effectiveness of healthcare services for people with diabetes within the district. The LDTs require data from the diabetes register to fulfil their function of reporting on the programme to the DHB and the Ministry of Health.
The programme operates alongside other national initiatives that contribute to caring for people with diabetes. For example, funding is available to PHOs and community groups to improve access to health services for people with high health needs by using innovative approaches to reach these people. Also, a national programme, Care Plus, was set up in July 2004 to provide co-ordination of care for people with chronic conditions and more complex needs.