New role of diabetes kaitautoko supported with digital tools

Publication date: 9 September 2021

Ministry of Health Digital Enablement funding will provide IT and digital device support for the new role of diabetes kaitautoko, being introduced in Taranaki. The role will be delivered by Ngāruahine Iwi Health Services, Tui Ora Whānau Health and Wellbeing Services and Ruanui Tahua Ltd who, with Taranaki DHB, form the Te Kawau Mārō Alliance.

The initiative has received funding from the Ministry of Health’s Digital Enablement Programme, which provides support for innovation in digital health care. The programme has a particular focus on co-investing in projects that improve access or participation for people who do not access health services and need to. It’s all about improving equity.

The Ministry is working closely with project teams, sharing learning between participating organisations as a community of practice and looking for opportunities to help others learn from these initiatives as they adopt and promote these or similar services elsewhere. The projects are examples of the types of innovation that will be supported by the better access to information enabled by the Hira programme.

Hira will be an ‘ecosystem’ of data and digital services that will enable consumers to access and control their health information through their choice of website or application using a digital device such as a smartphone, tablet or computer. New Zealanders will be more empowered to manage their health, wellbeing and independence. Organisations can work together to share information so that people don’t have to repeat personal details multiple times. Clinicians can harness digital technologies to improve services. The sector and digital innovators can design and contribute innovative data and digital services, making Hira more powerful.

The diabetes kaitautoko will be part of a team supporting whānau Māori with uncontrolled or out of control HbA1c levels. The diabetes integrated team also includes diabetes clinical nurse specialists, an endocrinologist/diabetologist, podiatrists, dietitians, and a psychologist. The service will span iwi, primary, specialist care.

The Digital Enablement funding will go towards technology to support the diabetes kaitautoko services, including:

  • FreeStyle Libre Sensors, giving people improved oversight to self-manage their diabetes
  • point of care testers for uric acid, to help identify gout
  • the development of a foot protection eMat, to identify diabetic foot ulcer
  • the development of diabetes reality software, that will connect the devices and data and send to the diabetes integrated team.

Ngāruahine kaiwhakarite (business manager) Warren Nicholls says the diabetes kaitautoko is a combination of a health coach and cultural support worker who walks alongside whānau Māori.

‘They will provide support for people to manage their diabetes themselves, identify and make plans to achieve their goals, and motivate them to make positive lifestyle changes. They will also bridge the gap between whānau Māori and their clinical care by accompanying and supporting people during investigations, assessments or procedures as required. It’s about helping people find their way around the health system.’

Project manager Carly Innes, from Taranaki DHB, says people will be supported in their homes, with the devices taking that support to the next level.

‘The devices will enable self-monitoring and the collection of important health data to ensure the diabetes integrated team has visibility to support whānau Māori to achieve their goals within their care plan.

‘The glucose monitors cost about $100 each per fortnight, so they are out of reach for a lot of people with diabetes. That’s where the equity side of things comes in – with the funding, we can provide these devices to a number of people. They are able to see what the trends are for their blood glucose and how those trends are affected by lifestyle factors.’

She says the kaitautoko will be closely connected to the diabetes clinical nurse specialist. ‘We will have all that clinical support to assist patients to make those decisions and guide the kaitautoko who’s working with whānau in the community. And they can have a zoom – the kaitautoko can go to the person’s house and they can connect with the nurse that way.

‘It’s a very new way of working, particularly with our clinical staff – understanding that our kaitautoko are part of this amazing solution, and that they will be part of the team. It’s a massive change piece.’

The Diabetes Service Level Alliance Team in Taranaki, which represents iwi, primary care and the DHB, has oversight of the project. Chair and advisor primary/secondary integration Dr Nadja Gottfert says it is amazing to be part of a piece of work that is system-changing and will have great outcomes for people in the future.

‘The kaitautoko approach is a really strong way to support those in the community who can’t access care – with transport and finances and all of those social complexities that are really challenging to address. So they won’t end up in the hospital on dialysis and they won’t end up dying early. But it needs to be sustainable; we hope we can make a long-term difference in people’s lives.’

She says new networks are being created.

‘From a whole diabetes network perspective, actually bringing people together, some who had just emailed each other but never actually spoken or met each other face-to-face.’

A service design agency helped with the co-design phase, which included talking with people with diabetes in their homes and in workshops. Themes and feedback were taken to a wider stakeholder group of health professionals, where concepts such as the kaitautoko role were tested.

‘We had the patient and whānau voice, and together with the health professionals, created a cross-spectrum view, which supported shifting the model of care towards a much bigger community focus,’ says Carly.

‘It was out of that co-design that it became clear the kaitautoko role needed to be part of the diabetes integrated team. That has really strengthened our model, so it’s not just about the clinical side of things, it’s also about the social elements that come into it. It was a real privilege to be part of that, to hear the stories and to see that we were going in the right direction.’

It is hoped results from the project will include improved diabetes outcomes for whānau Māori and longer-term, reduced hospital admissions and a reduction in lower limb amputation.

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