Integrating care for people with diabetes

Summary

NSW Health and the NSW/ACT Primary Health Networks (PHNs) are committed to working with partners in a ‘one health system’ approach, to improve the health outcomes and experiences of care for people living with diabetes. The NSW Ministry of Health (the Ministry) and the Agency for Clinical Innovation (ACI) have identified an opportunity to build on the existing diabetes management activities of local health districts (LHDs) and specialty health networks (SHNs), PHNs including general practice, Aboriginal Controlled Community Health Services (ACCHSs), primary and community care organisations.

Using the existing work of districts/networks and their partners to address diabetes as a starting point, the aim of this collaboration is to develop a statewide initiative that supports a more coordinated approach for diabetes management to keep people well and out of hospital. 

NSW Health is using a value based healthcare (VBHC) approach to develop and implement this statewide initiative. This approach strives to improve outcomes that matter to patients, the experiences of receiving and providing care, and the efficiency and effectiveness of care. It focuses on placing the patient at the centre of care and measuring outcomes that matter to them. 

The initiative outlines why an integrated approach to diabetes management is required in NSW and highlights what should be in place to achieve the outcomes. Under a more coordinated approach, people living with diabetes should be able to access and receive care that is:

  • appropriate to their needs and preferences, and supports them to achieve health outcomes that matter to them
  • provided in a timely, planned, coordinated and integrated manner
  • delivered by a team of health practitioners from general practice, primary, community, aged care and hospital settings.

The initiative provides guidance to ensure that appropriate services and partnerships are in place across all settings to improve diabetes care. Shared priorities supported by statewide and local authorising environments will enable system-wide improvements where needed.

The statewide initiative highlights six focus areas that all districts and their partners should consider addressing to improve diabetes care. The focus areas align with current programs of work, local circumstances, needs and capabilities. The initiative will define and measure common outcomes that NSW Health and its partners will work towards. 

File Size: 425 kb
Type: Strategy
Date of Publication: 01 March 2022
ISBN: 978-1-76023-147-7
SHPN: (SRP) 220257