1. Produced by The Alfred Workforce Development Team on behalf of DHS Public Health - Diabetes Prevention and Management Initiative June 2005 Recall and Reminder Systems DPMI projects Module 5.1

2. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Presentation purpose Target audience Project managers on DPMI projects Aim To explore concepts of recall and reminder systems Objectives (to precede discussion by GPDV of model programs) Provide an overview of planned care Explore the purpose and features of successful recall and reminder systems Discuss the barriers and facilitators Discuss issues for integration into DPMI projects

3. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Integrated Diabetes Management Identifying populations with, or at risk of, diabetes Implementing planned clinical or non clinical interventions, based on evidence of “best practice” and care pathways Measuring consumer outcomes once interventions are put into effect

4. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Features of successful planned care programs The provision of care in accordance with an explicit plan by multidisciplinary teams Systematic assessment Regularly scheduled follow ups Attention to the self-management needs of the consumer. (DCCT, UKPDS, HDFP.)

5. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Recall and reminder systems The provision of care in accordance with an explicit plan according to “best practice” and Systematic assessment Provide the information required for developing recall and reminder systems  When and why you want to recall clients  What outcome measures will determine success

6. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Purpose of recall and reminder systems Provide support to individual practitioners/consumers to adhere to recommendations for screening and review. Supports practice/program implementation of best practice Documents program performance If appropriate information collected, evaluation of outcome measures

7. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Recall and reminder systems Register of all diabetes, and or IGT, clients ( minimum data should include name, contact details, age, type of diabetes date of first contact and review dates) paper or electronic or may be incorporated into organisation client data base Individual client records ( case management check list, care plans, service coordination templates) Systematic client record review/case conference Audits Hand held records Post it alerts on records/initial contact forms/systems

8. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Recall and reminder systems Pitfalls  Can be time consuming to set up  May be perceived as over servicing  May foster dependence  Plateau/ceiling effect  Cost effectiveness uncertain Source “Putting Prevention into Practice” RACGP

9. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Hand held records Can improve preventative care Improvements in continuity of care Potential to reduce replication of tests Low cost Supports self management Barriers  HPs reticence to share records with client Dickey 1993 Patient Education and Counseling.

10. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Other Considerations Privacy and consent Integration into existing practices GP EPC items, PCP service coordination initiatives, organisational client management systems (eg Medical Director) Collecting appropriate data for follow up/evaluation with community screening

11. DPMI Workforce Development – The Alfred Workforce Development Team June 2005 Questions to ask What is the purpose and implications for recalls and reminders for the client, clients significant others, health professional including GPs, wider health system? What is the cost to client and community to recall or not recall? What is our projects best practice pathway and where do recall and reminders fit and feedback? What information and processes are essential and what are optional? What are the implications if the recall and reminder system lasts only the life of the project? What systems need to be in place to embed it into the community?