The prevalence of type 2 diabetes across Western Sydney Local Health District (WSLHD) is estimated by NSW Health to be 13%, based on telephone surveys conducted in 2019. However, 18% of adults attending local emergency departments or visiting GPs in WSLHD have returned blood test results consistent with diabetes, indicating a significant burden of disease within the district.
Western Sydney Diabetes (WSD) has found that a significant portion of the population with diabetes has HbA1c levels above 7%, indicating poor glycemic control and an increased risk of complications.
Establishing a diabetes case conference model
To address these issues, WSD proposed the Diabetes Case Conference model involving a multidisciplinary team of endocrinologists, dietitians and specialist diabetes nurses to provide care to high-risk patients. By utilising the myVirtualCare platform, WSD began offering video case conferencing with GPs, allowing them to transition to full virtual care during the COVID-19 pandemic.
WSD now offers five clinics for people with type 2 diabetes, including the Mount Druitt Community Diabetes Clinic. This clinic provides capacity building for GPs and patient stabilisation under the supervision of diabetes specialists. WSD has also developed educational resources, including instructional videos and GP masterclasses, to enhance the knowledge and skills of healthcare providers. A pharmacy working group has also been established, involving hospitals, community pharmacies and diabetes educators, to facilitate the application of flash continuous glucose monitoring devices through trained pharmacists or nurse-led clinics.
Utilising strong clinical leadership and sponsorship
Local planning, service design and governance were aligned between virtual and in-person services. Clinical protocols were established, including the requirement for a valid referral and a documented pathway for patient management. The service ensured accessibility for a diverse population, offering remote monitoring with a continuous glucose monitoring device and utilising the CareMonitor app for data collection. Key partners, including the Western Sydney Primary Health Network, GPs and pharmacists were actively engaged, with patients empowered through resources and support.
Appropriate technology including myVirtualCare for virtual consultations and the CareMonitor app was used. Implementation planning began in 2019 with strong clinical leadership and sponsorship. Data collection and funding mechanisms were established, utilising the WSLHD outpatient management system and the myVirtualCare platform for usage data. The project took a comprehensive approach, involving local planning, clinical protocols, remote monitoring, community engagement and partnerships with key stakeholders. The use of appropriate technology and strong leadership contributed to the project's success, with ongoing monitoring and funding mechanisms in place.
Enhanced integration and positive review of virtual care experience
Through the evaluation of the Mount Druitt service and the myVirtualCare platform, we have learned three important lessons and obtained valuable results:
- The virtual care model was strongly accepted by patients and healthcare providers, providing a convenient and timely service. It allowed enhanced integration and learnings from joint consultations, benefiting patient care.
- The myVirtualCare platform facilitated patient engagement, with respondents reporting high levels of involvement in decision-making and careful listening by health professionals.
- The evaluation results showed positive outcomes for the virtual care experience. WSLHD respondents reported higher rates of appointment availability (88%) compared to the NSW Health combined results (85%). Most respondents accessed the platform via Windows computers (41%) and smartphones (29%), with 82% reporting no connection issues. Patients expressed satisfaction with health professionals ability to explain things (97%) and the overall care received (73% rated it as very good).
These findings highlight the success of virtual care in improving access, patient engagement and overall satisfaction. They demonstrate the potential of virtual care to transform healthcare delivery and enhance diabetes management.
