The ACOC is a detailed minimum set of patient management steps that general practitioners (GPs) can claim through Medicare for the management and monitoring of diabetes. While many people have their diabetes clinically managed by a GP the actual number of patients completing (as distinct to the billing for) the ACOC is unknown
To benchmark how many patients with diagnosed diabetes are deficient in the pathology measures of the ACOC.
Private pathology laboratory data for the 2012 calendar year provided for each HbA1c test was cleaned and duplicates removed; - Reports by date, gender, postcode, HbA1c value, Lipid profiles, eGFR, creatine, microalbumin, albumin creatinine ratios results were provided
Of the diabetes patients for whom we have data in the 2012 calendar year - 10.4% did not have renal function tested, 14.3% did not have lipids measured and 67.5% did not have an ACR or micro-albumin measure.
DISCUSSION AND CONCLUSIONS:
We cannot manage what we don’t measure. The data suggests that in patients with diabetes there is a high percentage who for some reason have not had an eGFR or a TC but have had a HbA1c when this could easily have been performed on the same sample of blood. It is possible that patients may have had a HbA1c with one provider and lipids or ACR with another. Given the frequency of HbA1c tests we feel that though possible the probability of this is low. When the total sample population is viewed at least 67.5% have not had the minimum pathology necessary for the annual cycle of care monitoring of patients with diabetes. When pathology is the easiest of all the minimum requirements to perform, these results raise the questions as to why these deficits are evident and what other minimums are missing and in whom and where? Is there a geo-epidemiological clustering?