Type 2 Diabetes: Medicare EPC referrals to private practice dietitians, do they work?

Abstract

The Australian Government Medicare Enhanced Primary Care (EPC) initiative for chronic disease management (CDM) enables patients with Type 2 diabetes (T2D) to access subsidised consultations with dietitians. This research aimed to investigate the changes in weight and waist circumference of patients with T2D under the care of a dietitian within the framework of the Medicare EPC initiative. An observational study was conducted over nine months which included 129 participants (58.9 ± 15.7 years, 32.2 ± 5.6 kg/m2) diagnosed with T2D. Patients were referred to see the dietitian via an EPC referral under a GP Management Plan and Team Care Arrangement (CDM items 721, 723) and were eligible for one, to a maximum of fi ve subsidised consultations. Weight and waist circumference were collected by the dietitian at each consultation. Information regarding service utilisation, previous dietetic care and length of T2D diagnosis was also collected. Statistically signifi cant reductions in body weight (1.9 ± 2.9 kg, p ≤ 0.05) and waist circumference (2.0 ± 4.8 cm, p ≤ 0.05) were observed from the initial to fi nal consultation. Participants who attended more than two consultations with the dietitian lost signifi cantly more weight than those who only attended two consultations (3.7 ± 4.15 kg vs 1.1 ± 1.6 kg, p ≤ 0.05). Almost one third of participants (n = 38, 30%) did not fully complete their referred consultations with the dietitian. Modest weight and waist circumference changes are achievable for patients with T2D within the framework of the Medicare CDM program. These changes are not likely to be clinically signifi cant in the short term. Results suggest that increasing the number of times patients visit a dietitian may facilitate better health outcomes.