Implement Diabetes Service Programs - Case Study Example

Project Plan: Diabetes Name Course Lecturer Date Table of Contents Table of Contents 2 1.0 Introduction 3 1.1 Project statement 3 1.2 Background 4 1.3 Importance of the project 5 1.4 Project Purpose 5 1.5 Project scope 5 1.6 Benefits 6 1.7 Theoretical frame work 6 1.8 Objective 7 2.0 Literature review 7 2.1 Diabetes in Australia 7 3.0 Assumptions and Constraint 12 3.1 Assumptions 12 3.2 Constraints 13 4.0 Project Governance 13 5.0 Project Design 14 6.0 Project time frame 14 7.0 Budget 14 8.0 Communication plan 15 References 16 1.0 Introduction 1.1 Project statement To undertake a study in order to develop and implement diabetes service programs to assist people in the marginalized regions and indigenous people in Australia. 1.2 Background Diabetes is listed as the fastest growing chronic disease in Australia that results to severe complications. These include stroke, blindness, heart attack, foot ulcers and kidney damage. It is obvious that the country is experiencing an epidemic that threatens the health system. It is confirmed that rate of mortality in the rural and remote areas due to diabetes is on the increase. Indeed, statistics have it that the rates are two to four higher in these areas as compared to the major cities in Australia. With this understanding there is a need to provide health services in order to help those individual living with diabetes (Philips 2003). The National Diabetes Service Scheme (NDSS) operates in Australia and aims at supporting people with diabetes to manage and understand their life with diabetes. In addition ensure that they have reliable, timely and affordable access to the services and supplies they need in order to effectively manage their situations. This is a great initiative by the Australian government and at the moment managed by Diabetes Australia. The initiative is eligible to every resident of Australian diagnosed with diabetes by a recommended medical practitioner. In order to make sure that every diabetes patient, mainly from the remote and rural areas access the services offered by NDSS, there is a need to maintain and continue to improve the services offered by the scheme. The project plan will aim at developing the much needed guidance on the growth and implementation of the national development programs in order to offer effective services to the marginalized people in Australia. 1.3 Importance of the project This topic is important to the wellbeing of the Australian population and more significant to the people living in the rural and remote parts of Australia. This is because latest data has indicated that there is an increase of diabetes in the country. More so among people who 25 years and above. There is a need for people to gain knowledge the appropriate health measures to take in order to prevent diabetes. In addition, those who already are diabetes need to equip themselves the required tools in order to be able to live a normal life despite the conditions and avoid other complications related to diabetes. Indeed, understanding the programs of NDSS will not only help those suffering from diabetes but it will also assist the population that is more prone to the disease. 1.4 Project Purpose The project plan will provide a definition of the project and provide a literature review of diabetes in Australia –type of diabetes and its prevalence in Australia in the last recent years. In addition the plan will provide guidance and an outline on the development and implementation of national programs in relation to diabetes in Australia. It will cover the processes from first identifying and planning all the activities to evaluation and finally a national roll out. 1.5 Project scope The project plan will develop and implement programs that will used to address diabetes in remote and rural regions in Australian. The activities undertaken will target Torres Strait and Aboriginal peoples, mental and psychosocial impacts of managing and living diabetes, the young people, diabetes in pregnancy, the elderly and those individuals from linguistically and culturally diverse communities and have diabetes. In addition, the activities that will be undertaken will indeed meet the objectives of the National Development Programs by developing, extending, enhancing or even implementing new services and resources, addressing various opportunities for the growth of services and resources to address the basic needs of the programs and being applicable nationally. 1.6 Benefits Achievement of the project scope should contribute to the a reduction of the high rate of diabetes prevalence among the marginalized community in Australia. 1.7 Theoretical frame work Rates of mortality as a result of diabetes have been on the increase in Australia. The greater burden of this disease is largely attributed to the major social determinants in life. Therefore, there is a need to pursue and implement programs that are essentially significant in providing services and products to those people who are diabetic. The development and implementation of the programs should be vigorously carried out among those people who are disadvantages in the society. This includes the indigenous communities, young people and the elderly in various remote and rural areas in Australia. As per the National Aboriginal Strait Islander Health Survey 2004-2005, the occurrence of diabetes among the Torres Strait Islander and Aboriginal people is at 6 per cent while those living in the rural and remotes region having a higher prevalence of 9 per cent. These rates are higher compared to diabetic people living in the major cities where the prevalence rate stands at 5 per cent. Adjusting age difference, the Torres Strait Islander and Aboriginal people, they are four times likely to have diabetes when compared to the non-indigenous people. It is obvious that people in the rural areas are burden by the disease and this is mainly attributed partly to social determinants of health. Despite the fact that there are national programs that have been initiated in these regions such as Healthy Communities Initiative, there is a need to implement and develop other effective programs given the fact that the government is spending more money on health promotions in these regions. Enhancing national programs in the marginalized regions in order to assist people susceptible and suffering from diabetes in the rural and remote areas is the central interest of this project. It is obvious that the implementation of the developed programs will not only assist the marginalized people but it will also make sure that sufficient fund is allocated in order to meet the health requirement of the people. 1.8 Objective To develop and implement programs that will result to an increase of diabetes health services and products to people living in the remote and rural areas including the Torres Strait Islander and Aboriginal people in Australia 2.0 Literature review 2.1 Diabetes in Australia Diabetes has been numbered as the sixth cause of death in Australia. It is estimated that almost one million Australians have diabetes. According to AIHW (2000) almost half of these cases are said to be undiagnosed. In the past two decades the rate of diabetes has trebled. The epidemic is mostly fed by type II diabetes, that is, about 85 % of the diabetes cases. However, there is limited information, nationally, on the incidences of diabetes in the country. Individual with diabetes are said to be more prone to various type of diseases and some medical problems (Philip 2003). Significantly, people with diabetes are four likely compared to people without to develop cardiovascular diseases. This simply implies that any strategy to prevent to prevent diabetes will significantly reduces cases related to cardiovascular diseases. Philips (2003) asserts that long term implications of diabetes include neuropathy, limb amputation, and pregnancy complication, impotence in men, and blindness before the age of 55 years, foot ulcers and periodontal diseases (Ali & Maron, 2006). In 2000, it was recorded that more than 64, 000 Australians had disability as a result of diabetes. The cost of health system was at $567 million in 2005. This accounts for the complications of diabetes (AIHW 2000). Among the Torres Strait and Aboriginal Islander communities are among the highest rates in the world Type 1 diabetes is exception as they are incidents data from 1999. Still, incidence data that is state-level has been established from New South Wales and Western Australian since 1980s (Philip 2003).The are no modifiable risks factors that have been defined for type1 diabetes. However, it is believed that environmental and genetic factors are involved in the development of this type (Thow & Waters 2005). Environmental factors that are being researched include nutrition a viruses (Philip 2003). As earlier seen, there is limited information to be used to determine the accurate number of Australians who are has type diabetes 1. The available data on type 1 diabetes indicate that it accounts for 13 per cent of the reported diabetes cases. There is a significant increase of the incidence of this type of diabetes between 1999 and 2005 (AIHW 2000) between the age of 0-14 the incidence increased from 18 per 100, 000 population in 1999 to 22 in the year 2005(Ali & Maron 2006). However, the incidence remained fairly stable for people aged between 16 and 30. Comparing with other OECD countries, the incidence of Type 1 diabetes, Australia was at the upper end of the stated range. Type 2 diabetes is the common form of diabetes in Australia. It mainly occurs in individuals at the age of 40 and above. This condition is marked by a decrease in insulin or less effective of insulin. Various numbers of risk factors are known to implicate in the development of this type of diabetes. Some of these factors may act alone while others act together. They include genetic such as family history and ethnicity, behavioral and lifestyle such as obesity and diet, and metabolic or biomedical. From studies done, it has been estimated that almost 840,000 adults of age above 25 years had Type 2 diabetes in 199-2000 (Miller & Knox, 2004). This constitutes 7 per cent of the population. Between 2004 and 2005, Type 2 diabetes accounted for 83 per cent of all diabetes. This constitutes 3 per cent Australians. It is important to note that in both data given, there was a higher prevalence in males as compared to the females and that this type of diabetes increases with age (Miller & Knox 2004). According to the National Health Surveys, the prevalence of Type 2 diabetes has indeed been on the increase significantly in the recent years (Philips 2003). Between 1999 and 2005, the increase has gone up by 1.2 per cent (Ali & Maron 2006). An increase in the rate of age-standardization does not only reflects a likelihood of an increase in Type 2 diabetes but also a higher percentage of people surviving with Type 2 and an rise in detection of the condition ( Thow & Waters 2005). The indigenous people of Australia have lower health standards as compared to the non-indigenous Australian. Not only genetic diversity attributes to this but also the fact that the people have poor health amenities. As such the rate of diabetes is higher compared to the rest (Brown & Davis 2005). With the high increase of urbanization and a change to sedentary life, an upsurge in the occurrence of lifestyle diseases among the indigenous has been observed. This includes diabetes mellitus whose upward trend in the recent years far exceeds the same case as observed in the rest of the Australian population. Notably, risk factors for diseases have been classified as non-modifiable (genetic, sex and age) and modifiable factors, that is, lifestyle. Indeed, social determinants are also recognized by medics as a contributor to the inequalities of health status in Australia (Bruce & Davis 2005). The above factors are superimposed on a condition of genetic susceptibility to the two types of diabetes. Illness and health seem to be led by a social gradient whereby individual who are at a lower social economic position are seen to have worse health status as compared to those who have higher social economic status. According to various studies done it has been observed that those group in the lower social economic status in Australia (the indigenous and those living in the marginalized regions) have a higher proportion of individuals suffering from diabetes compared to the rest of the population especially those living in the major cities (Bate & Jerums 2003). When diabetes was reported among the indigenous people in Australia, the main cause was attributed to genetic susceptibility. According to Neel (Coory 2003) the diabetic gene was said to be thrifty therefore, conferring survival benefit in food shortages. As a result the genotype renders one susceptible to diabetes and obesity in the present day. Nevertheless, it is quite clear that there is a coexistence between type 2 diabetes and obesity as a result of Western lifestyle but this is not only limited to the indigenous communities. However, poor nutrition in utero or infancy stage increases the risks of developing diabetes 2 later in life. According to (Craig & Broyda 2007) indigenous infants and children have high rate of low birth rate that is mainly associated with insulin resistance. However, this has not been physiological been made clear (Craig & Broyda 2007). The multifactorial model has been used to illustrate diabetes prevalence among the indigenous people in the country. The risk of having diabetes in both sexes among the indigenous is fairly similar to other Australians. For instance, Aboriginal men and women have a higher risk of developing diabetes type 2 than the counterpart in the Australian population thus, there are present of other factors that contribute to the risks of developing diabetes apart from clinical data and individual’s lifestyle. The multifactorial model may seem complex but when analyzed is easily understood. It may be broken down into two categories that finally affect the result of a disease (Marmot & Taylor 2003). Firstly, proximal factors are present and directly concerned every individual. Such factors include the changes that are related to Western diet and change in sedentary lifestyle that results to obesity and excess gain of weight. Nevertheless, more distal forces operating at societal or community level affects the variables. History has it that the Aboriginal people have for a long time been subjected to racial prejudice, political and social marginalization (Gracey & King 2009). It is obvious that these conditions have resulted to detrimental flow on effects on job opportunity and education resulting to subsequent poverty. The suggested risk factors are then amplified by remoteness. Under investment in infrastructure and lack of health amenities in the remote and rural areas broaden the already created health gap. However, it is important to note that this model does not only apply to the indigenous people but does to the rest of the Australian population. With any population, there will be a given amount of heterogeneity that contains a significant genetic admixture. Thus, this model of a disease may always be regarded as a universal because of the varying circumstance, background and predisposition (Gracey 2007). It is significant to emphasize that type 2 diabetes is preventable and therefore, health burden among the indigenous people can be reduced. However, this is only possible if the correct strategies are laid. According to Gracey (2007) the most appropriate measure is the involvement of the government and the community living in the marginalized areas. Marmot (2007) asserts that there is also a need to involve some health organizations that will double the effort in assisting the marginalized group. Indeed, one of the major measures to tackle the epidemic is through mitigating obesity epidemics. This is the primary prevention target as it will reduce the risk of children developing diabetes later in life. Programs implemented through children health is an excellent approach in investing in the future generation (Trewin 2006). A secondary form of prevention is through regular and cost effective diabetes screening among the young and older generation while the tertiary measures may involve the introduction of education programs directed at promoting programs and education among the indigenous people living in the marginalized areas in the country at the moment (O'Dea & Brown 2007). 3.0 Assumptions and Constraint 3.1 Assumptions The below assumptions were made in preparing the project plan The marginalized are willing to embrace the development programs that will be offered by the project The management will ensure that all the team members are available and ready to carry out the task Failure to follow the given rules and responsibilities will result to delay of the project All team members will adhere to the communication plans Project may change due to the reveal of new information 3.2 Constraints Resources availability are inconsistent The level of commitment by some management members is low 4.0 Project Governance Good governance is a key effective in a project administration. The governance arrangement of the project will be expected to achieve a clear and share understanding of the responsibilities of those involved in the development and implementation of the program. The department of Marginalized Group is a key decision maker in the project. It will be mandated with approving any strategic plans raised by the members. It will communicate and receive reports from the Diabetes Australia. Diabetes Australia is responsible for creating, management, implementing and reporting all aspect of the program. Other key players in the project include the Medical, Education and Scientific advisory Council that will be established to support the NDSS programs, NDSS agents that will play a significant role of developing and delivering the support services. Projects teams will be drawn from NDDS agent, Diabetes Australia, a NGO and an independent consultant. They will undertake each activity as assigned. Financial management will be in accordance to the arrangement of NDSS and Diabetes Australia. The agreement signed will be used to approve the annual plan, strategic plan and budget. Any conflicting arising in the governance management will be managed and identified by the Diabetes Australia. 5.0 Project Design The design of the project accurately identifies and meets the requirement of the targeted audience the design is done in a systematic comprehensive manner. The design will definitely allow the allocated resources to be used efficiently and effectively. The project design will includes involvement of the stakeholders and an evidence based requirement assessment. 6.0 Project time frame 7year (January 2013- August 201) It is important to note that the timeframes may be affected by the delay in the approval of the project. 7.0 Budget 8.0 Communication plan It is crucial that all participants in the project experience the executive guidance and support. Therefore, the executive will speak to all levels. Communications outreach will be done through monthly status reports, monthly meetings, website use and bi-monthly project team leaders meeting References AIHW 2000, Diabetes as a cause of death. Canberra: AIHWA. Ali, Y., & Maron, D.2006, Screening for coronary isease in diabetes. When and how. Clinical Diabetes , 24(4): 169–173. Bate, K., & Jerums, G. 2003, Preventing complications of diabetes. Medical Journal of Australia , 179:498–503. Brown, L., & Davis, W. 2005, A prospective study of depression and mortality in patients with type 2 diabetes: the Fremantle Diabetes Study. Diabetologia , 48:2532–39. Coory, M. 2003, Can a mortality excess in remote areas of Australia be explained by Indigenous status? A case study using neonatal mortality in Queensland. Australian and New Zealand Journal of Public Health , 27(4):425–7. Craig, M., & Broyda, V. 2007, Type 2 diabetes in Indigenous and non-Indigenous children and adolescents in New South Wales. . Diabetes Medicine , 186:497–99. Gracey, M. 2007, Nutrition related disorder in Indigenous australians; how things have changed . Medical Journal Australia , 186(1) 15-7. Gracey, M., & King, M. 2009, Indigenous health part 1: determinants and disease patterns. Lancet , 374: 65-75. Marmot, M. 2007, Achieving health equity; from root causes to fair outcomes. Lancet 70: 1153-63. Marmot, M., & Taylor, S. 2003, Closing the gap in a generation: health equity through action on the social determinants of health. Lancet , 72:1661-9. miller, B., & Knox, S. 2004, General practice activity in Australia 2003–04. Canberra : AIHW. O'Dea, K., & Brown, N. 2007, Diabetes in indigenous Australians; psssible ways forward. Medial Journal Australia , 186(10): 495-5. Philip, G. 2003, Impact of ICD coding standard changes for diabetes hospital morbidity data. Canberra : AIHW. Thow, A., & Waters, A. 2005, Diabetes in culturally and linguistically diverse Australians:identification of communities at high risk. Canberra : AIHW. Trewin, D. 2006, National aboriginal and Torres Strait Islander Health Survey. Canberra: ABS. Read More