Targeting Diabetes and Cardiovascular Disease

Objectives

Improve prevention, early detection, treatment and self-management of diabetes and cardiovascular disease (CVD) in order to reduce avoidable illness, disability and premature mortality.[1]Focus services and health-promotion activity on Māori, Pacific peoples, people of South Asian origin, and other communities facing elevated risk or barriers to care.[1][2][3]The strategic framework combines national health targets, absolute CVD-risk assessment, comprehensive diabetes care and community-led prevention.[1][4][5]

• Increase the proportion of eligible adults who have received a CVD risk assessment within the previous five years.[1]
• Increase attendance by people with diabetes at free annual diabetes checks and increase the proportion achieving satisfactory or better diabetes management.[1]
• Provide people with diabetes with systematic screening for risk factors and complications, an updated treatment plan, and appropriate treatment or referral.[4]
• Assess CVD using an individual’s combined five-year absolute risk rather than isolated risk factors, and reduce five-year risk to below 15 percent through lifestyle change, medicines and diabetes care where appropriate.[4][5]
• Strengthen diabetes self-management through regular clinical checks, tailored advice, education, lifestyle support and appropriate medicines.[2][3]
• Build accessible heart-health awareness through local people and community organisations, including activity encouraging Māori and Pacific men over 35 years in high-need regions to seek heart checks and adopt healthier lifestyles.[3][6]

Implementation

Deliver the strategy through coordinated work by the Ministry of Health, District Health Boards, Primary Health Organisations, general practices, community health providers, clinical professionals, community representatives and people living with diabetes.[7][2][6]Link CVD risk assessment with diabetes detection, screening, treatment and regular reassessment in accordance with revised evidence-based guidance.[7][4][5]The document does not specify overall budgets, financing arrangements, resource gaps or economic assumptions.[1][7][6][4][8]

• Support District Health Boards and general practitioners to improve early detection and management of diabetes and CVD, including innovative outreach for high-risk and disadvantaged people who have not received a CVD risk assessment.[1][7]
• Provide free annual diabetes checks, regular medical, eye and foot checks, dietetic advice, nursing support and subsidised medicines within relevant diabetes programmes.[7][2]
• Coordinate local service improvement through Local Diabetes Teams, bringing together primary and secondary care professionals, community representatives and people with diabetes for quarterly performance reviews.[2]
• Extend care into communities through mobile retinal-screening clinics and a Whānau Ora-based model that involves families in supporting diabetes and chronic-illness self-management.[2][6]
• Implement One Heart Many Lives as a community-driven model using adaptable local resources, social-marketing guidance, community development expertise, festivals, community days, local champions and health checks.[3][6]
• Develop locally relevant communication resources, including cardiovascular risk cards, websites, community stories and magazines, and promote personalised self-management through the Heart Age Forecast tool and tailored six-week heart plans.[3][5][8]
• Disseminate the revised New Zealand Cardiovascular Guidelines Handbook through printed copies, online resources, video clips, frequently asked questions and practitioner education sessions for general practitioners, practice nurses, pharmacists, Māori and Pacific health providers, and stroke and cardiac-care workers.[4][5]
• Strengthen data-led improvement through a single patient-data repository, electronic practice ratings, dashboards, linked prescription, laboratory, hospital, medication and treatment data, and Ministry of Health-aligned analysis.[6][4]
• Monitor implementation using national health-target measures, quarterly regional and District Health Board reviews, retinal-screening coverage, practice ratings, dashboard data, handbook distribution, website use and practitioner-session attendance.[1][7][2][6][5]
• Use reported performance information to identify service improvements, while recognising that no broader formal evaluation framework, complete indicator set, overall reporting schedule or explicit accountability sanctions are specified.[7][2][8]

Monitoring & Evaluation

Monitoring centres on national health-target measures for cardiovascular disease (CVD) risk assessment, annual diabetes checks and diabetes management, supported by quarterly performance review, linked health data and service-level dashboards.[1][7][6][4]

• Monitor the proportion of eligible adults receiving a CVD risk assessment within the previous five years, the proportion of people with diabetes attending free annual checks, and the proportion achieving satisfactory or better diabetes management.[1]
• Review district and regional performance quarterly through multidisciplinary health professionals and Local Diabetes Teams, identifying areas for service improvement against national health targets.[7][2]
• Report progress against health targets, which provide a clear and specific focus for action; more than 70 percent of eligible adults had received a CVD risk assessment, with year-on-year improvement reported.[7][8]
• Track retinal-screening coverage, with the West Coast reporting 80 percent coverage and an aim of 90 percent among people requiring screening.[2]
• Use evidence on statin use and premature CVD mortality differences to target the One Heart Many Lives initiative towards Māori and Pacific men in high-need regions.[3]
• Monitor District Health Board performance through quarterly reports and national targets; Whanganui District Health Board moved from last among 21 boards in November 2009 to fifth in November 2010.[6][4]
• Strengthen diabetes surveillance by linking prescription, laboratory, hospital, medication and treatment data, with participating Primary Health Organisations reporting data-matching accuracy above 95 percent.[4]
• Collect Get Checked programme data to improve diabetes services, and use practice ratings, a single patient-data repository and population dashboards to follow patient progress and support service-improvement accountability.[6][4]
• Reassess individual CVD risk regularly under the revised risk-assessment and treatment approach.[5]
• Track dissemination and implementation reach through handbook distribution, website use and practitioner-education attendance; 19,500 handbook copies were distributed, the website received over 9,000 hits, and more than 800 practitioners attended education sessions.[5]

The available material does not specify a single formal evaluation framework for the overall action plan, a comprehensive indicator set beyond the health-target and service measures, a universal reporting timetable beyond quarterly reviews, or formal accountability sanctions.[1][7][2][3][8]

Costing & Financing

Financing information is limited. The initiatives include resource-intensive delivery mechanisms, such as free annual diabetes checks, retinal screening, data systems, education sessions and community programmes, but no overall budget, expenditure total, funding source, allocation, funding gap or economic model is specified.[7][2][6][5][8]

• Provide subsidised medicines as part of the Counties Manukau diabetes programme, without specifying the subsidy value, programme cost or financing source.[2]
• Distribute 19,500 copies of the revised CVD guidelines handbook and provide online resources and practitioner education, without reporting associated costs or funding arrangements.[5]
• Operate in a tight fiscal environment while seeking to improve health-service quality and efficiency; no quantitative economic assumptions or savings estimates are provided.[8]
• Exclude specified information on resource mobilisation measures, funding shortfalls, District Health Board allocations, donor financing, unit costs and cost-effectiveness analysis.[1][7][3][6][4]