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GPs key for equitable access to glucose monitors: RACGP


Alisha Dorrigan


6/07/2023 5:58:46 PM

An ongoing NDSS review has sparked renewed calls to allow GPs to certify patients with diabetes for access to subsidised continuous glucose monitors.

GP discussing CGM with a patient.
Continuous glucose monitoring technology provides wide-ranging benefits for patients.

A tender is underway at the Department of Health and Aged Care (DoH) that is looking to ‘refresh’ the products available to eligible patients through the National Diabetes Service Scheme (NDSS).
 
The scheme, which provides subsidised access to a range of products that enable patients with diabetes to self-manage their blood sugar levels, includes basic items such as glucose test trips alongside newer technologies like insulin pump consumables and continuous glucose monitoring (CGM) devices.
 
While the DoH has said it is aiming to ensure that community needs are met, it is also reviewing the cost-effectiveness of subsidised products and is not expected to change product categories or expand eligibility criteria.
 
The RACGP has provided feedback as part of the tender, highlighting current equity and access issues to CGM technology and putting the issue of NDSS certification back in the spotlight.
 
Since July last year, all patients with type 1 diabetes mellitus (T1DM) have been eligible to access CGM devices through the NDSS; however, GPs have been blocked from facilitating this process, creating what the RACGP says are unnecessary barriers for patients.
 
In the college’s submission, President Dr Nicole Higgins called for GPs to be allowed to certify patients for access to subsidised CGM products, an exclusion that has previously been described as ‘nonsensical’.
 
‘This decision creates unnecessary barriers to patient access to appropriate and timely care, particularly for rural and regional patients who may rely completely on their GP for care,’ she wrote.
 
‘GPs play a fundamental role in the prevention, diagnosis, and management of diabetes … [and] are usually the most accessible health service.
 
‘In circumstances when managing patients with T1DM is not part of an individual GP’s usual practice or they don’t feel they have the necessary skills to certify access, they would seek advice for certification from another member of the healthcare team.’
 
CGM technology has been a game changer in diabetes management and provides wide-ranging benefits for patients, such as reducing the need for fingerpick testing and alerting users if their blood sugar is either too high or too low.
 
Devices may also be integrated with smart phones and insulin pumps, allowing for tighter blood sugar control and data sharing with carers and healthcare providers.
 
Dr Gary Deed, Chair of RACGP Specific Interests Diabetes, echoed the RACGP’s submission and reiterated that GPs will work with patients to ensure they are adequately supported to use CGM technologies. He also said that restrictions on certification are not evidence-based.
 
‘Many patients have issues of poor access to specialists and qualified allied health professionals due to cost and also social isolation, etcetera,’ Dr Deed told newsGP.
 
‘The only issue is that CGM should be linked to adequate education of patients in understanding how to apply the outputs to clinical care changes, for example insulin adjustments.
 
‘As long as the GP is adequately satisfied the patient has the clinical supports to undertake the implementation and ongoing use of the CGM then it should not be an issue.
 
‘Specialist groups have feared that people applying for the CGMs will not seek adequate specialist or qualified allied health support to receive the education and patient training in the clinical utility of CGM devices. This is an assumption not backed by any current evidence.’
 
The submissions period has now closed, with the DoH indicating that it will consider the feedback when planning the updated tender process for NDSS products. It has not said when this will be completed.
 
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diabetes glucose monitors National Diabetes Services Scheme NDSS


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