December 12, 2019

Staying Well with diabetes in the North

Northern Health has partnered with Eastern Melbourne Primary Health Network and DPV Health to pilot an integrated, multidisciplinary health care model targeting diabetes, called ‘Staying Well with Diabetes in the North.’

The project team, along with Dr. Suresh Varadarajan, Head of Endocrine Services and Briana Baass, Chief Allied Health Officer and Partnerships, met with some of the GPs, Dr Kashif Murtaza and Dr Syed Arif Ahmed, at Mill Park GP Super Clinic, DPV Health, to highlight the service pilot which commenced on Tuesday, 10 December.

Briana explained the ‘Staying Well with Diabetes in the North’ project is a multi-streamed service that has been collaboratively developed and implemented using a phased approached to achieve its intended outcomes. The multi-disciplinary wraparound service in the community will include a Northern Health Endocrinologist going out to community health services, with the aim to reduce the need for patients to attend appointments at the hospital.

“This will enable a collaborative service, in particular with simultaneous collaborative planning including the patient, DNE and Endocrinologist together. Also, it will enable knowledge transfer between acute and community services, and moves the intervention up-stream (type 2 diabetes in scope) with the intention to reduce the rising risk population,” Briana said.

Catarina Hart, Ambulatory Care Diabetes Coordinator, said type 2 diabetes is linked to a number of serious health conditions often resulting in unplanned hospital admissions.

“This project will help support those with type 2 diabetes in our community and reduce their need to go to hospital,” she added.

Dr. Suresh Varadarajan Head of Endocrine Services, Northern Health, said, “The number of people in our catchment diagnosed with Type 2 diabetes is increasing. Despite our excellent results from our HARP and other diabetes programs, this is an area in which we can do more to keep our community well and out of hospital.”

Collaborative health care models are reported to reduce the likelihood of health system fragmentation and in turn likely to result in improved health outcomes for persons living with chronic and complex diseases. This first stream of the Staying Well with Diabetes in the North, together with planned further streams, strives to enhance our collaborative partnerships with our existing partners as well as establish new, non-traditional partners to help us achieve our shared vision for enhancing health and wellbeing in the north.

“This project offers us a unique opportunity to challenge ourselves in terms of using true partnerships to achieve system transformation. It allows us as a system to provide holistic, connected care out in the community. It helps us to shift our focus upstream; and that is very exciting for people living in the north,” Briana added.


Featured image (left to right): Kathryn Cirone (DPV Health, Team Leader – Wellbeing Advisory Services) Janet Rahman (DPV Health, DNE)  Dr. Suresh Varadarajan (Northern Health, Head of Endocrine Services), Dr Syed Arif Ahmed (DPV Health, GP), Dr Kashif Murtaza( DPV Health, GP), Allison Mason( DPV Health, Practice Nurse), Catarina Hart (Northern Health, Ambulatory Care Diabetes Coordinator), Briana Baass (Northern Health, Chief Allied Health Officer and Partnerships) and Caitlyn Brennan (Northern Health, Project Manager).