Background: Comprehensive Diabetes Management Program [CDMP] is a web-based telehealth application facilitating optimal diabetes management by multidisciplinary partnerships with primary care practitioners (PCPs) and patients. CDMP was developed in the US over a decade ago in order to reduce increasing and unsustainable demands on specialty services and to reduce health inequality in under-resourced communities. HbA1c levels and retinopathy screening rates improved with implementation of CDMP.
TEAMSnet partners include the US Indian Health Service, The University of Hawaii, the Aboriginal Medical Services Alliance Northern Territory (AMSANT), The University of Melbourne, Centre for Eye Research Australia (CERA), the NHMRC Clinical Trials Centre at the University of Sydney, the South Australian Health and Medical Research Institute, the NT Aboriginal Medical Clinics at Congress, Wurli and Miwatj and the Fred Hollows Foundation.
Aims: To increase the number of Indigenous Australians adhering to the recommended cycle of diabetes care, particularly primary care visits and retinopathy screening; provide PCPs with electronic decision-support tools, care plans, education materials and web-based multidisciplinary communication in order to facilitate evidence-based diabetes and CVD management and achieve accepted clinical targets.
Method: Data from six hundred Indigenous patients with diabetes will be collected at enrolment (baseline) and then at 6 and 12 month visits. Data collected will include the frequency of hospitalisations and out-patient clinic visits; HbA1c, blood pressure and lipids, and PCP’s utilization of CDMP tools. Changes in clinical outcomes and cost-effectiveness analyses will be undertaken.
Conclusion: CDMP has the potential to improve efficiency and outcomes in diabetes management in Australia, while simultaneously reducing costs.