Jayne Lehmann RN CDE
Blood glucose monitoring strip restrictions are about to impact on the 789,985 Australians who are not prescribed insulin to manage their type 2 diabetes. Credentialled Diabetes Educator Jayne Lehmann looks at the implications for Credentialled Diabetes Educators (CDEs) and other health professionals in this two-part blog. Look out for the practical tips to help you through the process.
The latest NDSS type 2 diabetes snapshot (to 31 March 2016) reports 1,036,819 individuals with type 2 diabetes are registered for the NDSS in Australia. Of these, 246,834 use insulin to treat their diabetes (NDSS, 2016). That means more than 789, 985 people are likely to be affected by the new BGM restrictions.
From the 1 July 2016 people with type 2 diabetes not using insulin will be eligible for 6 months of BGM strips from their first purchase on or after 1 July 2016. NDSS supplies can be purchased only from community pharmacy NDSS outlets as Diabetes Australia outlets are closing. As many purchases as required can be made during this time, within NDSS.
After the first 6 months of strips, they will need a review with their Credentialled Diabetes Educator, doctor or nurse practitioner to see if they have a clinical need for ongoing BGM.
If individuals meet one or more of the following criteria, a further six months of BGM access can be approved:
- The person has an inter-current illness that may adversely affect blood glucose control
- The person is undergoing treatment with a medicine that may adversely affect blood glucose control
- The person’s diabetes is inadequately controlled
- There is a clinical need for the person to self-monitor their blood glucose control
- There has been a change to the person’s existing diabetes management within the previous three (3) months
Put together a user friendly handout to guide people through the changes.
Have a look at my YouTube video on the changes. Share with people with diabetes and colleagues as another education strategy.
BGM strips have been delisted from the Pharmaceutical Benefits Scheme (PBS) 1June 2016. This means people can no longer access BGM strips using a prescription. This will have an impact on those who chose not to register with the NDSS because they got their strips with a prescription.
Another group impacted by this decision will be tourists who run out of BGM strips during a holiday. They will need to pay full price for the strips through a community pharmacy but may need to wait a day or so for stock to be ordered into the store as they will be unlikely to hold stock for non NDSS supply.
Check people are registered with the NDSS and arrange registration as required
There are going to be many people confused about the changes unless an easy read version is produced. People with any of the following will struggle to understand the government’s written information already distributed:
- Acquired brain injury
- Communication disorder
- English as a second language
- Learning disorder
- Low health literacy
- Intellectual disability
Design an easy read option for those with low health literacy. Advise carers of people with diabetes and disability or in aged care of the changes. If educating individuals with poor English skills, ask for them to bring someone with them with good English or arrange a translator. There appears to be no translated versions of the letter to people with diabetes on the NDSS site.
Peak impact – holiday season
The true impact of the scheme will fall in January 2017, coinciding with the holiday season for many health professionals authorised to sign the form confirming clinical need. A staggered introduction should be possible because people will be due for their authorisation six months after their first BGM strips purchase on, or after, 1 July 2016.
Use the next six months to prepare people. Review BGM technique, individualise monitoring regimens, check they know their target levels pre and post meals and discuss how they can work within the new guidelines. People will need a solid understanding of what constitutes a ‘clinical need’ for ongoing self BGM. Design a time efficient handout to give each person written information to take home.
Use the opportunity to market your service to the local GPs. Highlight that you can explain the new arrangements to people with type 2 diabetes not using insulin, assess clinical need, sign the form and educate on structured BGM for individualised advice. Promote the time you can save them and that your skills complement rather than replace those of the practice nurse.
Stock Piling Strips
Stockpiling of strips is inevitable, especially during the first 6 months of strip access. This will increase risk in the future of inaccurate BGM results if expired stockpiled strips are used. People not aware of the changes will not be able to maximise strip purchases just before the changeover to full implementation 1 January 2017.
Ask people to bring their monitoring equipment to appointments and review technique. Discuss how they can make the most of the first 6 months of BGM strip access during the lead-in period but discourage stockpiling. Remind to check strip expiry dates and increased risk of inaccurate results with expired stock.
Part 2 of this blog looks at more of the implications for CDEs from the introduction of these new restrictions. The potential risks, managing conflict and benefits of structured BGM will be explored. A practical and printable table outlining examples of clinical need to approve BGM strips under the changes will be provided for CDEs, doctors and nurse practitioners to use as a ready reckoner.