Part 1: Introduction

1.1
Diabetes is a major health issue for New Zealand. Reducing the incidence and effect of diabetes has become one of the Government’s population health priorities. Diabetes is also one of eight priority areas for improving Māori health. The “Get Checked” programme (the programme) was started in June 2000 as part of the strategic response by the Ministry of Health (the Ministry) to diabetes management. (For more information on diabetes and the programme, see Part 2).

1.2
In this Part, we discuss:

• why we carried out our audit;
• the scope of our audit;
• our expectations; and
• how we carried out our audit.

Why we audited the “Get Checked” programme

1.3
We carried out a performance audit of the programme because it is a key accountability mechanism for ensuring that general practices are adequately managing diabetes care. It gives people who have been diagnosed with diabetes access to a free annual health check, to help them better manage their condition and lower the risks of complications arising from having diabetes.

1.4
The failure to manage many preventable complications for diabetes means that those with the disease may require expensive medical interventions. A large portion of these costs is preventable through good management of diabetes.

1.5
The Ministry of Health describes the programme as the foundation for diabetes services, and it is designed to improve the co-ordination of services delivered by all health care providers.

The scope of our audit

1.6
Our audit assessed the effectiveness of the programme in achieving its objectives, which are to:

• systematically screen for the risk factors and complications of diabetes to promote early detection and intervention;
• agree on an updated treatment plan for each person with diabetes;
• prescribe treatment and refer people for specialist or other care if appropriate;
• update the information in the diabetes register, which is used as a basis of clinical audit and for planning diabetes services in the area;
• improve the planning and co-ordination of services delivered by all healthcare providers; and
• decrease the barriers to accessing high quality care for Māori and Pacific Island peoples.

1.7
Our audit did not look at what was being done to identify those people with diabetes but who had not been diagnosed, and nor did it look at individual treatment and outcomes.

Our expectations

1.8
We developed our audit objectives and audit expectations from the programme’s objectives.

1.9
Our first audit objective was to determine whether the programme was operating as intended. We expected that:

• people diagnosed with diabetes were being systematically screened through the programme for the risk factors and complications of diabetes to promote early detection and intervention;
• an updated treatment plan was agreed for each person participating in the programme; and
• participants in the programme were being prescribed treatment and referred for specialist or other care if appropriate.

1.10
Our second audit objective was to determine whether the information from the programme was being used to improve diabetes services. We expected that:

• programme administrators would be accurately entering information from the annual programme checks in the diabetes registers;
• the information in the diabetes registers was being used to promote improvements in diabetes services and as a basis for clinical audit; and
• local diabetes teams (LDTs) and district health boards (DHBs) would use the information in the diabetes register to co-ordinate and plan diabetes services in their districts.

1.11
Our third audit objective was to determine whether the programme was achieving the expected results. We expected that:

• the barriers to Māori and Pacific Island peoples accessing high quality care would have decreased; and
• the programme would be improving the management of diabetes.

How we carried out our audit

1.12
District health boards are responsible for funding the programme and ensuring that it is delivered in their districts.

1.13
We selected six DHBs – Auckland, Counties Manukau, Tairawhiti, Hawke’s Bay, Capital & Coast, and Otago – and interviewed representatives of their planning and funding staff and their clinical staff in specialist diabetes services. We also interviewed staff from 12 primary health organisations (PHOs) within those DHB districts.

1.14
We spoke to staff from the programme administrators (the organisations funded by DHBs to administer the programme and maintain the diabetes registers – see the glossary for a fuller description). These organisations included nine of the 12 PHOs in our sample as well as a community organisation, an independent practitioners association, and one of the DHBs.

1.15
We interviewed members of five LDTs and staff from the Ministry of Health, and met with staff of the Royal New Zealand College of General Practitioners.

1.16
We also obtained copies of relevant documentation from all the organisations involved in the audit.

1.17
We selected our sample to give us access to districts where the programme was operating well and districts where the programme appeared to be having difficulty. We also selected districts with significant numbers of Māori and Pacific Island peoples. This was because one of the main objectives of the programme was to improve access to good quality care for these sectors of the population, which are particularly at risk of diabetes.

1.18
Throughout this report, we have named DHBs where findings are specific to particular DHBs. We have also highlighted some examples of good practice that we found in specific PHOs and programme administrators, and have named the organisations concerned.

1.19
The population sizes and ethnic profiles of the districts that we visited are set out in Figure 1.

Figure 1
District health board population size and ethnic profile for our sample

a: Auckland DHB website, www.adhb.govt.nz.

b: Capital & Coast District Health Board Health Needs Assessment Second Edition – Version One, September 2004, page 14, and Capital & Coast District Health Board 2005/06 Annual Report, page 8.

c: Counties Manukau DHB website, www.cmdhb.org.nz.

d: Hawke’s Bay District Health Board District Annual Plan 2006-2007, page 12.

e: Otago District Health Board District Strategic Plan 2005-2015, page 10.

f: Strategic Health Plan for the Te Tairawhiti District – Hauora Titiro Whakamua Health Looking Forward 2005-2010, page 16.