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Table 2 Description of workforce model applied to type 2 diabetes.

From: A work force model to support the adoption of best practice care in chronic diseases – a missing piece in clinical guideline implementation

1 and 2. Scope and health status of the study region: Diabetes selected as the target health condition. Establish health status (epidemiology) of regional population, reflecting an understanding of diabetes and protocols for prevention and management by interrogating available data sets; (for example as listed in Table 2). Describe number of persons with diabetes type (Type 2, Type 1, gestational) by disease stage – recently diagnosed, with specific comorbidities (vision impairment, neuropathy, foot problems, renal failure, heart disease), and persons at risk (e.g., combinations of IGT, obesity, previous gestational diabetes, high risk ethnic groups, aged over 50).
3. Define best practice care: Document clinical best practice for management of diabetes by type of diabetes and identifiable disease stages, highlighting the role of various skills. For persons with recently diagnosed NIDDM, describe optimal care over, say, five years in terms of consultations with diabetes nurse educator, podiatrist, dietitian, physical activity specialist; conduct a similar exercise for persons with specific complications and for persons at risk.
4. Translate best practice protocols into skill requirement per person: for the newly diagnosed diabetic, persons with specific comorbidities and complications, and persons at risk. Express as mean hours by allied health skill/person/year at each disease stage, i.e., hours/persons for Sa1 to Sai......... Sn1 to Sni W here: Sai is skill type 'a' (e.g., dietetics) for population subgroup 'i' (e.g., person with newly diagnosed NIDDM).
5. Translate mean hours into an EFT skill requirement for each skill type: (podiatrist, dietitian, diabetes nurse educator, etc.), by combining mean hours for each skill type per person per year with estimated numbers in each diagnostic category
   Multiply (Sa1 to... Sn1) × H1........ to (Sai. to Sni) × Hi.
   Where Hi is number of persons in disease category/stage
Adjust for typical contact hours per occupational group to arrive at EFT requirement. Consider whether aim is to achieve best practice care or 'acceptable' care, and what this might mean.
6 and 7. Translate skill requirement into a service requirement and match against current supply: by taking results from step 5 together with local knowledge of allied health workforce, opportunity for multi-skilling or specialised care, geography of region, distribution of population, possible approaches to program delivery, nature of the client population. Compare with current skill mix and service structure.
8. Establish budget implications: Determine funding level required to support the projected service requirement. Compare with current resourcing levels. Consider how funding might be split between levels of government and program area. Consider balance between private and public funding.
9 & 10. Monitor, review and adjust: Create a plan for frequency of revision and adjustment based on nature of evidence for diabetes and characteristics of the region.