Hi
@pist87
Great questions.
We have guidelines underpinned by clinical evidence on diagnosis, management and monitoring you might want to refer to:
http://www.racgp.org.au/your-practi...ssessment/73-what-should-be-evaluated-yearly/
Always useful for me to review the guidelines too!
It's very difficult to talk about the 'average' diabetic and the typical frequency of visits. Everyone is different biologically, socioeconomically, their attitudes to health, monitoring and medication - and all of these need to be taken into account; hence the 'patient-centred' approach.
Nevertheless to try and give you a simple answer then yes, there would be some patients of mine where MHT could be used. Speaking
generally it might work for the well controlled T2DM either managed by diet and exercise alone or on one oral hypogylaecemic only, without complications, well controlled blood pressure and evidence of good cholesterol control. All things being equal I suppose that person could be seen once or twice a year. Without MHT it would be one visit to review clinically, send away for testing, and then a second visit to review again with those results. If say we implemented a new medication, I would give them a pathology slip to do before the next review in say 3 months time. So that's two visits or if including that follow-up review to me that's
three visits.
With MHT it could possibly go: patient sends test beforehand, reviews result with me, if all good then it's
one visit, possibly
two if we need a review. A standard GP consult costs medicare $37 so from a cost of consultation point of view MHT may save $37-$74 per patient all other things being equal.
Where it falls down a little bit depends on other often associated conditions particularly cholesterol, blood pressure and kidney function. As you can probably appreciate there is a significant likelihood that these are conditions also seen in diabetics. It's therefore likely they may require annual cholesterol checks or blood and urine tests for kidney function for monitoring but also to help guide medications (some medications can't be used if deteriorating renal function). Now the MHT will provide the Hba1c but no information on these other parameters. In which case, even if a patient has brought to me a MHT HbA1c result, it's quite likely I'm going to send them off for a cholesterol blood test or blood or urine test for their kidneys as well - in this situation, MHT has not resulted in fewer visits to the doctor.
So in summary, yes I think there could be a role for MHT in some carefully selected patients who might enjoy the convenience and save medicare $37-74 a year (1 or 2 visits) but I don't think this will apply to the majority of patients, at least not in my cohort anyway.
