Murrumbidgee DREAM team – bringing specialist diabetes care to rural NSW

Limited access to specialists and allied health services, which are often restricted by availability, cost, and long waitlists, are just some of the common challenges faced by people living with diabetes in the Murrumbidgee region of New South Wales. But thanks to the local implementation of the Diabetes Regional Education, Access, and Management (DREAM) Initiative, these barriers are being addressed.

“It really is a dream,” said St Vincent’s Health Network Sydney Diabetes Clinical Nurse Consultant Gael Holters of the DREAM initiative. “Being in the Murrumbidgee is helping us better understand the unique challenges and needs of rural communities in managing diabetes, but equally important is patients having equity of service with their city cousins,” Ms Holters said.

In 12 months, the Murrumbidgee DREAM initiative has supported 203 people with diabetes through 15 general practice clinics in the rural communities of Tumut, Gundagai, Young, Hay, Adelong, Leeton, Lake Cargelligo, West Wyalong, Griffith, Henty, Finley, Oaklands, and Cootamundra; and 94 health professionals across 15 general practices have participated in one or more professional development sessions.

The program was co-designed with local healthcare providers to ensure the solutions meet the specific needs of communities in the Murrumbidgee and is a result of a collaboration between St Vincent’s Health Network Sydney, St Vincent’s Curran Foundation, Murrumbidgee Local Health District and Murrumbidgee Primary Health Network (MPHN).

Compared with all NSW Primary Health Networks, MPHN has a higher rate of diabetes hospitalisations and the highest prevalence of diabetes, affecting more than 10 per cent of our total adult population. For MPHN, who is leading the project’s implementation, this is a statistic they are hoping to change through the DREAM initiative.

MPHN CEO Stewart Gordon said offering patients access to local specialist services, which complement existing specialists and primary care providers is pivotal to improving health outcomes. “Through DREAM, we tailor an approach to best fit the local circumstances, ensuring we're not just implementing standard protocols, but crafting solutions that reflect the realities of rural life, and in turn addressing social determinants of health often associated with both diabetes management and the tyranny of distance to healthcare services,” Mr Gordon said. “The DREAM clinics are empowering local clinicians and supporting patients with self-care tools and expert knowledge, we’re helping to ensure healthier futures for communities across the Murrumbidgee.”

DREAM initiative Founder, St Vincent’s Hospital Sydney Head of Department of Endocrinology and Director of Diabetes Services, Professor Jerry Greenfield said the program was helping to address social determinants of health. “Having the specialist come to the patient, rather than the patient needing to travel to see the specialist, which can be both expensive and time consuming, removes barriers for diabetes care in the rural and regional areas,” Professor Greenfield said. “This style of consultation allows our team to educate GPs on the latest developments in diabetes medication and care. It’s very rewarding to work with local healthcare professionals to ensure the rural and regional population have access to the best possible and equitable care and experience.”

During the DREAM Mobile Health Service clinics, patients receive tailored diabetes education from diabetes educator Gael Holters, followed by in-depth consultations with an endocrinologist. Follow-up telehealth appointments with the DREAM team are scheduled six months later to provide ongoing support and monitoring.

“Some patients have only received medication education in relation to managing their diabetes, and for people with lower health literacy this often isn’t enough. During the consultation we seek to understand the patient’s social factors around education, work, life and mental health before providing a full head to toe experience with information about complications, home blood glucose monitoring, new devices, feet check and talking about foot care are all important factors in diabetes education and management,” Ms Holters said. “We’re grateful for the support of MPHN in facilitating the involvement of local practices. Their collaboration has been invaluable in extending our reach and impact, and I am pleased to report patient reviews show positive outcomes including improved overall blood glucose levels and weight management – like I said earlier – it’s a dream for everyone, especially for the people we are supporting.”

The St Vincent’s Health Network Sydney DREAM initiative is made possible through the St Vincent’s Curran Foundation. For more information about the initiative visit MPHN’s website.