Advertisement

Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES—Australia

  • Timothy Skinner
    Affiliations
    Rural Clinical School, University of Tasmania, TAS, Australia
    Search for articles by this author
  • Penny Allen
    Correspondence
    Corresponding author. Tel.: +61 364304550; fax: +61 364315670.
    Affiliations
    Rural Clinical School, University of Tasmania, TAS, Australia
    Search for articles by this author
  • Elizabeth Peach
    Affiliations
    Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC, Australia
    Search for articles by this author
  • Author Footnotes
    1 Grant support: The National Diabetes Services Scheme, an initiative of the Australian Government administered by Diabetes Australia, funded the 2011 survey ($200,000) and a Sanofi-Aventis unrestricted educational grant funded website development ($20,000).
    Jessica L. Browne
    Footnotes
    1 Grant support: The National Diabetes Services Scheme, an initiative of the Australian Government administered by Diabetes Australia, funded the 2011 survey ($200,000) and a Sanofi-Aventis unrestricted educational grant funded website development ($20,000).
    Affiliations
    The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, Melbourne, VIC, Australia

    Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia
    Search for articles by this author
  • Frans Pouwer
    Affiliations
    Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
    Search for articles by this author
  • Author Footnotes
    1 Grant support: The National Diabetes Services Scheme, an initiative of the Australian Government administered by Diabetes Australia, funded the 2011 survey ($200,000) and a Sanofi-Aventis unrestricted educational grant funded website development ($20,000).
    Jane Speight
    Footnotes
    1 Grant support: The National Diabetes Services Scheme, an initiative of the Australian Government administered by Diabetes Australia, funded the 2011 survey ($200,000) and a Sanofi-Aventis unrestricted educational grant funded website development ($20,000).
    Affiliations
    The Australian Centre for Behavioural Research in Diabetes, Diabetes Australia – Vic, Melbourne, VIC, Australia

    Centre for Mental Health and Wellbeing Research, School of Psychology, Deakin University, Burwood, VIC, Australia

    AHP Research, Hornchurch, United Kingdom
    Search for articles by this author
  • James A. Dunbar
    Affiliations
    Greater Green Triangle University Department of Rural Health, Flinders University and Deakin University, Warrnambool, VIC, Australia
    Search for articles by this author
  • Author Footnotes
    1 Grant support: The National Diabetes Services Scheme, an initiative of the Australian Government administered by Diabetes Australia, funded the 2011 survey ($200,000) and a Sanofi-Aventis unrestricted educational grant funded website development ($20,000).

      Abstract

      Aim

      To investigate differences in access to services and health outcomes between people living with Type 1 (T1DM) and Type 2 (T2DM) diabetes in rural/regional and metropolitan areas.

      Methods

      Diabetes MILES—Australia was a national postal/online survey of persons registered with the National Diabetes Services Scheme. Selected variables, including utilisation of health care services and self-care indicators, were analysed for 3338 respondents with T1DM (41%) or T2DM (59%).

      Results

      Respondents from rural/regional (n = 1574, 48%) and metropolitan areas were represented equally (n = 1700, 52%). After adjusting for diabetes duration, demographic and socioeconomic variables, rural/regional respondents with T1DM (RR 0.90, 95% CI 0.83–0.97) and T2DM (RR 0.69, 95% CI 0.59–0.81) were less likely to report consulting an endocrinologist during the past 12 months. Rural/regional respondents with T1DM were more than twice as likely to have accessed a community/practice nurse for diabetes care (RR 2.22, 95% CI 1.25–3.93) while those with T2DM were more likely to have accessed a diabetes educator (RR 1.21, 95% CI 1.07–1.36) or dietician (RR 1.17, 95% CI 1.07–1.36). For the T1DM and T2DM groups were no differences between rural/regional and metropolitan respondents in self-reported hypoglycaemic events during past week and the majority of self-care indicators.

      Conclusions

      Despite a lack of access to medical specialists, respondents with T1DM and T2DM living in rural/regional areas did not report worse health or self-care indicators. The results suggest that multidisciplinary primary services in rural areas may be providing additional care for people with diabetes, compensating for poor access to specialists.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Diabetes Research and Clinical Practice
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Australian Institute of Health and Welfare
        Rural, regional and remote health: indicators of health status and determinants of health.
        Australian Institute of Health and Welfare, Canberra2008 (Cat. No. PHE 97)
        • Australian Institute of Health and Welfare
        Rural, regional and remote health: mortality trends 1992–2003.
        Australian Institute of Health and Welfare, Canberra2006 (Rural health series No. 7, Cat. No. PHE 71)
        • Australian Institute of Health and Welfare
        Rural, regional and remote health: indicators of health.
        Australian Institute of Health and Welfare, Canberra2005 (Rural health series No. 5, Cat. No. PHE 59)
        • Australian Institute of Health and Welfare
        Rural, regional and remote health: a study on mortality.
        2nd ed. Australian Institute of Health and Welfare, Canberra2007 (Rural health series No. 8, Cat. No. PHE 95)
        • Sicree R.
        • Shaw J.
        Type 2 diabetes: an epidemic or not, and why it is happening.
        Diabetes Metab Synd: Clin Res Rev. 2007; 1: 75-81
        • Phillips A.
        Health status differentials across rural and remote Australia.
        Aust J Rural Health. 2009; 17: 2-9
        • Begg S.J.
        • Vos T.
        • Barker B.
        • Stanley L.
        • Lopez A.D.
        Burden of disease and injury in Australia in the new millennium: measuring health loss from diseases, injuries and risk factors.
        Med J Aust. 2008; 188: 36-40
        • American Diabetes Association
        Standards of medical care in diabetes – 2011.
        Diabetes Care. 2011; 34: S11-S61
        • Overland J.
        • Yue D.K.
        • Mira M.
        Use of medicare services related to diabetes care: the impact of rural isolation.
        Aust J Rural Health. 2001; 9: 311-316
        • Wan Q.
        • Harris M.F.
        • Davies G.P.
        • Jayasinghe U.W.
        • Flack J.
        • Georgiou A.
        • et al.
        Cardiovascular risk management and its impact in Australian general practice patients with type 2 diabetes in urban and rural areas.
        Int J Clin Pract. 2008; 62: 53-58
        • Unger C.C.
        • Warren N.
        • Canway R.
        • Manderson L.
        • Grigg K.
        Type 2 diabetes, cardiovascular disease and the utilisation of primary care in urban and regional settings.
        Rural Remote Health. 2011; 11: 1795
        • Smith K.B.
        • Humphreys J.S.
        • Wilson M.G.A.
        Addressing the health disadvantage of rural populations: how does epidemiological evidence inform rural health policies and research?.
        Aust J Rural Health. 2008; 16: 56-66
        • Anderson R.M.
        • Funnell M.M.
        Patient empowerment: myths and misconceptions.
        Patient Educ Couns. 2010; 79: 277-282
        • Department of Health UK
        National service framework for diabetes: standards.
        Department of Health, London2001
        • Lawlor A.
        • Fraser D.A.
        • Lindsay R.S.
        • Ness A.
        • Dabelea D.
        • Catalano P.
        • et al.
        Association of existing diabetes, gestational diabetes and glycosuria in pregnancy with macrosomia and offspring body mass index, waist and fat mass in later childhood: findings from a prospective pregnancy cohort.
        Diabetologia. 2010; 53: 89-97
        • Speight J.
        • Browne J.L.
        • Holmes-Truscott E.
        • Hendrieckx C.
        • Pouwer F.
        Diabetes MILES—Australia (management and impact for long-term empowerment and success): methods and sample characteristics of a national survey of the psychological aspects of living with type 1 or type 2 diabetes in Australian adults.
        BMC Public Health. 2012; 12: 120
        • Snoek F.J.
        • van der Ven N.C.
        • Lubach C.H.
        • Chatrou M.
        • Ader H.J.
        • Heine R.J.
        • et al.
        Effects of cognitive behavioural group training (CBGT) in adult patients with poorly controlled insulin-dependent (type 1) diabetes: a pilot study.
        Patient Educ Couns. 2001; 45: 143-148
        • Horne R.
        • Weinman J.
        • Hankins M.
        The beliefs about medicines questionnaire: the development and evaluation of a new method for assessing the cognitive representation of medication.
        Psychol Health. 1999; 14: 1-24
        • Fialko L.
        • Garety P.A.
        • Kuipers E.
        • Dunn G.
        • Bebbington P.E.
        • Fowler D.
        • et al.
        A large-scale validation study of the medication adherence rating scale (MARS).
        Schizophr Res. 2008; 100: 53-59
      1. Australian Bureau of Statistics. Census of population and housing: socio-economic indexes for areas (SEIFA), Australia – Data only; 2006. At: http://www.abs.gov.au/ (accessed 24.04.12).

        • Yu Z.
        • Sun J.Q.
        • Haas J.D.
        • Gu Y.
        • Li Z.
        • Lin X.
        Macrosomia is associated with high weight-for-height in children aged 1–3 years in Shanghai.
        China Int J Obes. 2007; 32: 55-60
        • Diabetes Australia and The Royal Australian College of General Practitioners
        Diabetes management in general practice, guidelines for type 2 diabetes.
        Diabetes Australia, Canberra2011
        • Australian Government Department of Health and Ageing
        Medicare benefits schedule (MBS), primary care items, chronic disease management (CDM) medicare items.
        Department of Health and Ageing, Canberra2012
        • Jordan J.E.
        • Briggs A.M.
        • Brand C.A.
        • Osborne R.H.
        Enhancing patient engagement in chronic disease self-management support initiatives in Australia: the need for an integrated approach.
        Med J Aust. 2008; 189: S9-S13
      2. Australian Primary Care Collaboratives. Webpage: http://www.apcc.org.au (accessed 10.12.12).

        • Madden J.
        • Barnard A.
        • Owen C.
        Utilisation of multidisciplinary services for diabetes care in the rural setting.
        Aust J Rural Health. 2013; 21: 28-34
        • Shojania K.G.
        • Ranji S.R.
        • McDonald K.M.
        • Grimshaw J.M.
        • Sundaram V.
        • Rushakoff R.J.
        • et al.
        Effects of quality improvement strategies for type 2 diabetes on glycemic control: a meta-regression analysis.
        JAMA. 2006; 296: 427-440
        • Mc Namara K.P.
        • Dunbar J.A.
        • Philpot B.
        • Marriott J.L.
        • Reddy P.
        • Janus ED
        Potential of pharmacists to help reduce the burden of poorly managed cardiovascular risk.
        Aust J Rural Health. 2012; 20: 67-73
        • Krass I.
        • Armour C.L.
        • Mitchell B.
        • Brillant M.
        • Dienaar R.
        • Hughes J.
        • et al.
        The pharmacy diabetes care program: assessment of a community pharmacy diabetes service model in Australia.
        Diabetes Med. 2007; 24: 677-683
        • Krass I.
        • Mitchell B.
        • Clarke P.
        • Brillant M.
        • Dienaar R.
        • Hughes J.
        • et al.
        Pharmacy diabetes care program: analysis of two screening methods for undiagnosed type 2 diabetes in Australian community pharmacy.
        Diabetes Res Clin Pract. 2007; 75: 339-347
        • Strom J.L.
        • Lynch C.P.
        • Egede L.E.
        Rural/urban variations in diabetes self-care and quality of care in a national sample of US adults with diabetes.
        Diabetes Educ. 2011; 37: 254-262
        • Lynch C.P.
        • Strom J.L.
        • Egede L.E.
        Disparities in diabetes self-management and quality of care in rural vs. urban veterans.
        J Diabetes Complicat. 2011; 25: 387-392
        • Magliano D.J.
        • Barr E.L.M.
        • Zimmet P.Z.
        • Cameron A.J.
        • Dunstan D.W.
        • Colagiuri S.
        • et al.
        Glucose indices, health behaviors, and incidence of diabetes in Australia: the Australian diabetes, obesity and lifestyle study.
        Diabetes Care. 2008; 31: 267-272
        • Australian Institute of Health and Welfare
        Australia's Health 2012 No.13. Cat. No. AUS 156.
        Australian Institute of Health and Welfare, Canberra2012
        • McDermott R.A.
        • Tulip F.
        • Schmidt B.
        Diabetes care in remote northern Australian indigenous communities.
        Med J Aust. 2004; 180: 512-516
        • Perry L.
        • Steinbeck K.S.
        • Dunbabin J.S.
        • Lowe J.M.
        Lost in transition? Access to and uptake of adult health services and outcomes for young people with type 1 diabetes in regional New South Wales.
        Med J Aust. 2010; 193: 444-449