New Enhanced Primary Care MBS Item: Type 2 Diabetes Risk Evaluation (Item 713)
The purpose of this item is to support general practitioners (GPs) to address the health needs of patients 40 to 49 years of age who are at ‘high risk’ of developing type 2 diabetes. The ‘high risk’ score will be determined following the patient’s completion of the Australian Type 2 Diabetes Risk Assessment Tool. The aim of this item is to review the factors underlying the ‘high risk’ score identified by the Australian Type 2 Diabetes Risk Assessment Tool to instigate early interventions, such as lifestyle modification programs, to assist with the prevention of type 2 diabetes.
Why? Clinical trials have provided strong evidence that progression to type 2 diabetes can be prevented or delayed by lifestyle modification. Many Australians, particularly those aged 40 – 49 years, are at risk of developing type 2 diabetes through lifestyle factors relating to nutrition and physical activity. If undetected or poorly controlled, type 2 diabetes can result in acute and long term complications.
Eligible Population: The Type 2 Diabetes Risk Evaluation is targeted at people aged 40 to 49 years (inclusive) who are at high risk of developing type 2 diabetes.
Assessing a ‘high risk’ score and conducting a Type 2 Diabetes Risk Evaluation The Type 2 Diabetes Risk Evaluation is a review of the factors underlying the ‘high risk’ score identified by the Australian Type 2 Diabetes Risk Assessment Tool. Clinical factors that the GP should consider include:
• lifestyle, such as smoking, physical inactivity and poor nutrition;
• biomedical risk factors, such as high blood pressure, impaired glucose metabolism and excess weight;
• any relevant recent diagnostic test results; and
• family history.
As part of a regular consultation (billed under the appropriate attendance item) a GP may suspect that a patient may have, or be at risk of developing diabetes. The GP may consequently order diagnostic tests to exclude the presence of type 2 diabetes. If diabetes is diagnosed, the GP may determine that a chronic disease management item is clinically relevant. If diabetes is not diagnosed, the GP may advise the patient to complete the Australian Type 2 Diabetes Risk Assessment Tool (available at www.mgpn.com.au).
If the GP determines that the patient is not likely to have already developed diabetes, but the Australian Type 2 Diabetes Risk Assessment Tool indicates that the patient is at ‘high risk’, the GP may choose to undertake a Type 2 Diabetes Risk Evaluation during the same attendance (billed under item 713).
Medicare Eligibility
A Medicare rebate is payable for the Type 2 Diabetes Risk Evaluation only once every three years for any eligible patient, or where more than three years has elapsed since item 717 (45-49 health check) has been claimed by that patient. If a GP is unsure whether a patient has already received this service, they may call Medicare Australia, with the patient present, on 132 011.
Role of the GP
The GP is responsible for the conduct of the Type 2 Diabetes Risk Evaluation provided to the patient. The GP is
expected to take a primary role in the following activities:
• Reviewing and analysing the information collected (including the risk factors underlying the ‘high risk’ score
identified by the Australian Type 2 Diabetes Risk Assessment Tool);
• Making an overall assessment of the risk factors that contributed to the “high” risk score of the patient and their readiness to make lifestyle changes to address these identified risk factors;
• Undertaking and arranging relevant investigations;
• Making relevant referrals, including to lifestyle modification programs, and identifying appropriate follow-up;
• Providing information and advice to the patient, for example, to undertake lifestyle modifications, and/or the use of Lifescript resources. Access to subsidised lifestyle modification programs will require the provision of a formal referral letter including the provider number of the referring GP.
Role of other health professionals
Practice nurses, Aboriginal Health Workers and other health professionals may assist GPs in performing the Type 2 Diabetes Risk Evaluation, in accordance with accepted medical practice and under the supervision of the GP.This may include activities which:
• identify eligible patients through examination of patient records, patient information systems, and risk
assessment tools used within the practice; • collect information such as measuring height and weight (body mass index), waist circumference and blood pressure;• provide patients with information about recommended interventions, and actions the patient should take (at the direction of the GP) to encourage good health.
When: Type 2 Diabetes Risk Evaluation (Item 713) will come into effect from July 1, 2008
Rebate for Item 713: Fee $60.00 Benefit $60.00
For more information: For more information or support in relation to Item 713 please contact Jessica at Melbourne General Practice Network PH: 9347 1188 or check www.mgpn.com.au for further details.
