No change to Medicare diabetes care model

April 8, 2015

With the federal government preparing to hand down the 2015-16 federal budget in May, three of the health and wellbeing industry’s peak representative bodies, Exercise & Sports Science Australia (ESSA), Dietitians Association of Australia (DAA) and the Australian Diabetes Educators Association (ADEA), have called for continued funding through Medicare for existing health care service models for people with Type 2 Diabetes Mellitus (T2DM).

The call comes after the Australian Lifestyle Medicine Association recently released a proposal suggesting Shared Medical Appointments (SMAs) through Medicare — led predominantly by GPs and practice nurses — be introduced for T2DM management. ESSA, DAA and ADEA have lodged a formal submission with the Australian Government regarding the proposed SMAs.

ESSA Senior Industry Development Officer Katie Lyndon said the proposed SMA model did not reflect best practice service delivery, and overlooked the importance of specialised information provided by allied health practitioners (AHPs) to optimise patient health outcomes.

“Whilst we do acknowledge that a SMA model has some merit, the proposal put forward suggests GPs and practice nurses should largely replace qualified allied health practitioners in delivering these group sessions,” Ms Lyndon said.

“This has the potential to increase patients’ risk of adverse outcomes due to neglecting specialised and individualised interventions for people with T2DM such as nutrition therapy, exercise prescription and diabetes self-care education, which is required to successfully manage patient needs, risk factors and comorbidities (the presence of one or more additional disorders).”

“In essence, this approach will reduce the success of AHP group interventions for people with diabetes, lessening patient motivation and compliance and increasing financial costs to the government and medical practices.”

At present, the group allied health services offered through Medicare allow people with T2DM to access professional advice from Accredited Exercise Physiologists, Accredited Practising Dietitians and Credentialled Diabetes Educators.

Ms Lyndon said while ESSA, DAA and ADEA recognised the benefits of group-based interventions as a whole, there was a lack of relevant and credible research indicating the superiority of SMAs over the existing group-based allied health services.

“Given that trials and cost-benefit analyses associated with SMAs have not yet been carried out, it would be premature to implement this model without further assessment,” Ms Lyndon said.

“With this in mind, and with the current group-based allied health services performing well, we strongly discourage the exclusion of allied health specialised services from Medicare item numbers for people with T2DM or pre-diabetes.”

Ms Lyndon said group-based interventions formed an integral part of patient care, and posed a number of physiological, behavioural and social benefits to those with T2DM that could not be achieved through traditional one-to-one appointments.

“Evidence shows that group based interventions improve a patient’s self-management of T2DM through the increased peer support provided by others with the same condition,” Ms Lyndon said.

“Furthermore, research shows patient self-management results in fewer visits to the patient’s GP each year as patients have the education and support network to better cope with their condition.”

“Overall, the existing group treatment approach can improve integration between GPs, allied health and practice nurses, whilst also reducing costs to the Australian healthcare system and minimising complications and comorbidities.”

Ms Lyndon said with more than 3.3 million people expected to have T2DM by 2031 and health expenditure for the disease expected to increase substantially over the next two decades, effective health models were imperative to help slow the rising incidence of T2DM and to assist those living with the condition with adopting self-management strategies.

“We’re already seeing more and more strain being placed on our healthcare system associated with the rising incidence of T2DM, so the government needs to think long and hard before making any further cuts or alterations,” Ms Lyndon said.

“It really is crucial that Medicare continues to fund the tried and trusted group-based allied health services for T2DM management. We would also like to see this same approach be available to those with pre-diabetes as per evidenced based prevention of this chronic disease.”

To read the full submissions, find out more about ESSA or locate an Accredited Exercise Physiologist in your local area, please visit www.essa.org.au.

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Media contact
Kristen Roder, Fresh PR & Marketing
0406 546 461
kristen@freshprm.com.au

Background information
At present, the group allied health services offered through Medicare allow patients with T2DM to access professional advice regarding their condition from Accredited Exercise Physiologists, Accredited Practising Dietitians and Credentialled Diabetes Educators who specialise in exercise prescription, nutrition therapy and diabetes self-care education respectively.
Group-based interventions combine comprehensive consultations with education in a group setting as a means of managing chronic disease. The facilitated peer interaction assists in empowering individuals to take control of their health and self-manage their condition. Aside from the obvious time efficiencies delivered, group-based interventions have also been proven to result in higher patient and provider satisfaction.
On the other hand, the Shared Medical Appointments (SMAs) proposed by the Australian Lifestyle Medicine Association suggest group-based interventions should be delivered by a qualified general practitioner and facilitator (generally a practice nurse) rather than allied health professionals who specialise in the content being discussed.

About ESSA
Exercise & Sports Science Australia (ESSA) is the peak professional body for exercise and sports science in Australia and provides national leadership and advocacy on key issues. It supports its 4,000-plus members and the community through fostering excellence in professional practice, education, training and research.
Website: www.essa.org.au

About DAA
The Dietitians Association of Australia (DAA) is the peak body of dietetic and nutrition professions providing strategic leadership in food and nutrition and advancing the professional interests of the Association’s 5,800 members. For more information, visit www.daa.asn.au.

About ADEA
ADEA has become the leading organisation for healthcare professionals with a special interest in diabetes education. Credentialled Diabetes Educators (CDEs) are qualified to provide a client-centred approach to diabetes education and care, empower patients and assist them in dealing with daily self-management. They integrate diabetes self-management education with clinical care as part of a therapeutic intervention to promote physical, social and psychological wellbeing.

Website: www.adea.com.au

Official media spokesperson for this release
Katie Williams, ESSA Industry Development Officer
E: Katie.Williams@essa.org.au
P: 07 3862 4122

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