Recipe Name

Identify patients who are at risk of Type II Diabetes

Rationale

According to RACGP clinical guidelines1, Type 2 diabetes is the most common form of diabetes in Australia, although many cases remain undiagnosed.

There are several risk factors1 that make an individual at high risk of Type 2 diabetes. In this recipe we will look at patients with some of those risk factors such as:

  • People with BMI >=30 and age >=40 years
  • People with hypertension and age >=40 years
  • Women with history of gestational diabetes mellitus (GDM)
  • Patients taking anti-psychotic medication


    This may help practices identify patients who can be recommended for AUSDRISK or T2DM Diagnostic Testing.

Target

Patients at high risk of Type II Diabetes who can be recommended for AUSDRISK or T2DM Diagnostic Testing

CAT Starting Point

  1. CAT Open – CAT4 view (all reports) loaded.
  2. Population extract loaded and extract pane "hidden".
  3. Optional Only (star): Filter Pane Open and under the 'General' tab, "Active Patients (3x < 2 years)" selected.


    *The decision to select either "Active" or "All" patient is left to the practice to make

1 http://www.racgp.org.au/your-practice/guidelines/diabetes/3-screening,-risk-assessment,-case-finding-and-diagnosis/31-identifying-risk-of-diabetes-in-asymptomatic-patients/



Click Recalculate to apply the filter for active patients only.


  1. Patients with BMI >=30 and age >=40 years

In the Filters Pane

  • Select General tab then under Age enter '40' in the Start Age box.



  • Select Conditions tab then click Chronic tab. Check the box beside the No that is in bold under Diabetes. This will exclude patients with an existing diagnosis of diabetes.



  • Select Risk Factors tab then check the Obesity box under Other Risk Categories.



Click Recalculate.
Click Hide Filter.
If you want to see only those patients that have visited in the last 12 months or had multiple visits in the last 6 months, you may add more filter before you click Recalculate by following the steps in "Filter for patients that are frequently visiting your practice" below.


In the Reports Pane

  • Select Demographics tab. The graph shows the number of female and male patients at risk who are 40 years old above, without existing diagnosis of diabetes, and with BMI >30.



You can check the Select All box or the Female or Male legend if you want to see a separate list of female or male patients then click View Population. This will load a worksheet with the list of patients and their information particularly the last column that shows the assigned provider and date of last visit.


  1. Patients with hypertension and age >=40 years

In the Filters Pane

  • Select General tab then under Age enter '40' in the Start Age box.



  • Select Conditions tab then click Chronic tab. Check the box beside the No that is in bold under Diabetes. Then, under Cardiovascular check the Hypertension box. This will filter patients without existing diagnosis of Diabetes and patients with Hypertension.



Click Recalculate.
Click Hide Filter.
If you want to see only those patients that have visited in the last 12 months or had multiple visits in the last 6 months, you may add more filter before you click Recalculate by following the steps in "Filter for patients that are frequently visiting your practice" below.


In the Reports Pane

  • Select Demographics tab. The graph shows the number of female and male patients without existing diagnosis of diabetes but with hypertension and are age 40 years old above.



You can check the Select All box or the Female or Male legend if you want to see a separate list of female or male patients then click View Population. This will load a worksheet with the list of patients and their information particularly the last column that shows the assigned provider and date of last visit.



  1. Women with history of Gestational Diabetes Mellitus

In the Filters Pane

  • Select Conditions tab
  • Click Chronic tab
  • Check the No box in bold under Diabetes. This will exclude patients with an existing diagnosis of diabetes.
  • Check the Gestational box under Diabetes



Click Recalculate.
Click Hide Filter.
If you want to see only those patients that have visited in the last 12 months or had multiple visits in the last 6 months, you may add more filter before you click Recalculate by following the steps in "Filter for patients that are frequently visiting your practice" below.
In the Reports Pane

  • Select Demographics tab. The graph shows the number of female patients with Gestational Diabetes.



Click the Female legend or you can also click Select All then click the View Population button. This will load a worksheet with the list of patients and their information particularly the last column that shows the assigned provider and date of last visit.



  1. Patients taking anti-psychotic medication

In the Filters Pane

  • Select Conditions tab then click Chronic tab.
  • Check the No box in bold under Diabetes to exclude patients with an existing diagnosis of Diabetes.



  • Select Medications tab.
  • Click Medications-Other tab.
  • Check the Antipsychotics box under Mental Health.



Click Recalculate.
Click Hide Filter.


If you want to see only those patients that have visited in the last 12 months or had multiple visits in the last 6 months, you may add more filter before you click Recalculate by following the steps in "Filter for patients that are frequently visiting your practice" below.


In the Reports Pane

  • Select Demographics tab. The graph shows the number of female and male population taking anti-psychotic medication.



To see the list of patients in a worksheet you can either check the Select All box or the Female or Male legend then click View Population. This will load a worksheet with the list of patients and their information particularly the last column that shows the assigned provider and date of last visit.



  1. Filter by Ethnicity and Age to identify group of patients that can be recommended for AUSDRISK

As per RACGP guidelines, individuals should be screened for risk of diabetes every three years from 40 years of age for Non-Indigenous and from 18 years of age for Indigenous using AUSDRISK. After you select the filters as per risk factors criteria above, you can add the filters below before you recalculate to further filter by ethnicity or age.

  • In Filters pane, select Ethnicity tab. Depending on your target, you can check the Indigenous or Non Indigenous box.



To further filter by age still on the Filters pane, go to 'General' tab then enter the age either 18 or 40 at the 'Start Age' box under Age.



Click Recalculate.


  1. Filter for patients that are frequently visiting your practice

Patients that have visited in the last 12 months

  • In Filters pane, select General tab.
  • In the Date Range still on the Filters pane under Last Visit enter the date within the last 12 months.
  • Click Recalculate.




Patients that had multiple visits in the last 6 months

  • In Filters pane, select General tab.
  • Still on Filters pane, in Visits in last 6 mths under Activity select the number of visits.
  • Click Recalculate.



Create a prompt to display in Topbar

 

Remember you need to be in the CAT4 Daily View to be able to create prompts. Other pre-requisites are:

  • Topbar is installed
  • CAT4 is linked to Topbar via Edit/Preferences/Topbar - check here for details: Linking CAT4 to Topbar

 To start CAT4 in the Daily View, click on the 'Daily View' icon in the dashboard:



Once you have applied the filter(s) and displayed the patients of interest as described above, you can create a prompt that will be shown to all clinicians using Topbar if a patient meeting the prompt criteria is opened in their clinical system. The full guide is available at CAT PLUS PROMPTS and a short guide on how to create prompts in CAT4 can be found at  Creating a Prompt in CAT4

To start you have to use the drop-down menu at the bottom of the patient details report and select "Prompt at Consult - Topbar" then click on "Go" to give the new prompt a name.

 


The name you enter is the prompt text displayed in Topbar, so choose a simple but clear name that tells the clinician seeing the prompt what should be done.



 

To Export Patient List to Microsoft Excel:

1.  Click on the “Export Icon”  at the top of the Patient Reidentification window.

2.  Click on “Excel”

3.   Choose a file name and a location to save to (eg. Create a folder C:/ClinicalAudit/CAT Patient FollowUp)

4.  Click “Save”

 

The steps above will produce a list of patients with contact details in MS Excel which can then be used to:

1.   Go back through the individual patient records in the GP Clinical Desktop System (CDS) and update known records

2.  Phone patients to update their record

3.  Produce a mail merge to recall patients for follow up