We catch up with Pilbara GP Cara Sheppard to hear how she uses Diabetes Connect in her work caring for people living with diabetes. 

Dr Cara Sheppard works one week a month in the Pilbara for the Puntukurnu Aboriginal Health Service (PAMS), across five locations in the western desert.  

This is a region where 96 patients use the four dialysis chairs at PAMS every month, and she has quite a high caseload of diabetes, with around 10% of her patients diagnosed with the condition. 

For her, Diabetes Connect is the most useful as a way of staying across all patients in the region, not just the ones she sees personally. 

“There’s not always a doctor on the ground here, so I may be getting a phone call from a nurse and making decisions about a patient’s care remotely,” Cara says.  

“I’m generally ringing about the more complex patients – someone with an intellectual disability, co-morbidities, poorly controlled diabetes or those who are not engaging with the health services.” 

She says that a conversation with Diabetes Connect is often part of a longer thought process. “Sometimes the decision making is quite limited, but the thought process is detailed.” 

She finds that, on a practical level, being able to book a time to talk to an endocrinologist is more effective than trying to catch a registrar on the phone. “When I’m not actually seeing patients there is time for a more in-depth conversation. Whereas if I call a registrar, they can only really say a few things to me – it’s not my problem, it’s fine, specific management advice or a referral.” 

In contrast, an appointment with Diabetes Connect provides time to talk in detail. “We can really dig into the complexities, go back over the results and look into the history of a particular patient. When you ring someone up, they don’t have that time available.” 

Cara says it’s helpful that Diabetes Connect endos have a strong understanding of the context of regional and remote medicine.  

“Some of the more junior registrars don’t really appreciate the constraints within which we’re working. How long it takes us to get blood test results, for example. If they haven’t done rural work, they don’t always understand exactly how far away we are from services such as X-rays. The more experienced endos have been in the system long enough to understand the logistical issues.” 

Diabetes Connect also offers a necessary sounding board for GPs in more isolated regions.  

“It’s less about the minutiae of management, because for my patients there’s sometimes a lot more complexity. And it’s a safety net where I can document in my notes that I’ve spoken to an endo. We talk and throw ideas out there – are we doing the right thing, what else could we do?” 

She plans to make more use of the service’s multi-disciplinary case conferences.  

“I’ve been thinking about pulling a list of our poorly controlled patients and having a case conference, because we only have an endo visiting Newman three times a year.” 

Diabetes Connect can also make up for the lack of a permanent diabetes educator in remote and regional communities. Cara says hers comes every six weeks, but that doesn’t really work for insulin, where you need more regular contact.  

“If I was in Perth, I would not put someone on insulin until they had seen a diabetes educator, whereas out here I don’t have that luxury. A lot of the things we’d normally do around prescribing are not possible.” 

Going forward, Cara would love to see the service expanded over other specialities.  

“While I do have renal specialists I can call on, I would love to see this service more formally extended to renal medicine.” 

Dr Greg Ong from Diabetes Connect, who recently visited the Pilbara with diabetes educator Tara Savage, says that in a health care setting where there are significant challenges, every opportunity counts, because you don’t know how many chances you’ll have to intervene. 

“Then there are more practical issues to consider, from reliable refrigeration to food security to dealing with extreme weather and the distance to services, and it can be harder to know what the safest option is,” Greg says. 

Continuity of care is another issue when an area is dependent on locums.  

“GPs can also call Diabetes Connect and feel empowered to make decisions for patients they don’t know well. Talking to us can help you make those decisions.”