Utilisation of multidisciplinary services for diabetes care in the rural setting

Objective: To quantify utilisation of allied health care services by diabetics in rural NSW and explore reasons for any underutilisation. Design: Self-administered mail survey of 268 patients with diagnosed diabetes identified from practice registers. Setting: Two rural general practices. Participants: One hundred seventeen respondents with diabetes. Main outcome measure: Annual frequency of visits to allied health practitioners. Results: In the last year, 40.2% of patients had seen a diabetes educator (DE), 21.4% a dietitian and 47% a podiatrist. However, 25-40% of patients had never used each of the services. Reasons for nonutilisation were non-referral (35.9-68.0%) and lack of perceived need (40.6-59.0%). One third of patients who had not seen a DE in the last year thought their 'general practitioner (GP) provides a similar service'. However, mean annual GP visits (5.6) were significantly lower than urban and rural comparisons. Patients with formal management plans were, in the last year, twice as likely to have seen a DE and podiatrist, and reported two extra visits to their GP compared to those without. Conclusions: Rates of allied health service utilisation were not significantly lower than urban rates; however, there is room for increased uptake of multidisciplinary services. Patients who do not access these services may expect their GP to fulfil multiple roles within a limited number of visits and may not understand the role of other practitioners. Where allied health services are available locally, utilisation may be improved by increasing use of management plans and fostering awareness of the role of allied health practitioners in diabetes management.