Dr Justine Birchall graduated from the University of Melbourne Medical School in 1993. After completing her GP training in towns such as Timboon, Point Lonsdale, Drysdale, and Bannockburn, Justine returned to Melbourne. Dr Birchall has been able to maintain her interest across the breadth of general practice, enjoying caring for patients before birth and even through the final stages of life. She has a keen interest in preventative health care, particularly related to immunisation, nutrition, prevention of cardiovascular disease and cancer screening.

Bisa Romic RN is an experienced nurse with a keen interest in preventative health. Bisa’s passion for healthcare encouraged her to complete a Master of Nursing Science from the University of Melbourne. She honed her skills in emergency and surgical nursing, before moving into general practice in 2018. With a passionate interest in metabolic health, Bisa brings experience, passion, knowledge, and sensitivity to her current role as nurse manager at Eastbound Medical Clinic.

https://youtu.be/v7Zi_AGk5tg

summerizer

Summary

  • Session topic: implementation of therapeutic carbohydrate reduction (TCR) in general practice as a primary-care intervention for insulin resistance and metabolic disease.
  • Stated objective: create “time and space” in routine general practice to deliver lifestyle-focused care (including TCR), rather than limiting activity to acute presentations and procedures.

Speaker context and motivating events (as stated)

  • Nurse manager from Eastbound describes:
    • Personal catalyst in 2023 after hearing Peter Brukner on ABC discussing “Eat to Beat” with Leon Compton.
    • Subsequent intensive self-education (podcasts, books, conferences) aimed at metabolic health.
    • Clinical pattern recognition: frequent presentations of weight gain and rising HbA1c, particularly in perimenopausal patients.
    • Personal family history of dementia influencing motivation to address metabolic risk earlier.
  • GP describes:
    • Earlier exposure (2015) to a TED talk by Dr. Sarah Halberg as an inflection point toward metabolic health and TCR.
    • Perception of “old thinking” and guideline/policy constraints within established diabetes primary-care pathways.

Practice setting (Eastbound) and roles (as stated)

  • Clinic staffing described as:
    • 12 tenant GPs.
    • 4 treatment-room nurses.
    • Complex chronic disease nurses.
    • Diabetes nurses.
    • One CDM nurse operating full week.
  • Service mix described as:
    • Procedures and wound care.
    • High volume of health assessments.
    • Chronic disease management delivered with a structured team approach where GP consults occur within broader nurse-led workflows.

Care model elements described

  • Use of existing MBS-funded structures to support “slow medicine” and longitudinal lifestyle intervention:
    • Health assessments used as primary entry points for early identification of insulin resistance risk.
    • Chronic disease visits scheduled at ~3-month intervals.
    • “Interval” visits described for issues outside the chronic care plan, sometimes with a gap fee.
  • Described “annual cycles of care” structure:
    • A chronic coordination stream and a clinic stream, with patients moving between streams as needed.
    • Monthly nurse contact used in some program structures (veterans care mentioned as an analogue).

Implementation workflow for TCR (as stated)

  • Re-education phase:
    • Internal upskilling of clinicians and nurses; explicit framing that staff were “rookies” initially.
    • Development of teaching resources for rapid onboarding of GPs and registrars.
  • Patient identification:
    • Selection of candidates for TCR among existing patients, including those identified via health assessments and diabetes-related care.
  • Education and support:
    • Use of visual aids and practical food-environment prompts (e.g., printed materials intended for placement on refrigerators).
    • Use of external diabetes resources and webinars as part of staff and patient support.
  • Legitimization and external alignment:
    • Reference to a position statement released in November supporting TCR, and a subsequent (March 2024) partnership involving Diabetes Australia and Defeat Diabetes (as stated in the session).
  • Practice change management:
    • Explicit acknowledgement of resistance from clinicians; approach described as building confidence, addressing skepticism, and navigating deviation from standard policy/guideline norms.

Medication safety and monitoring themes (as stated)

  • Emphasis on structured monitoring and education when implementing TCR in patients with diabetes, including attention to medication use and reduction pathways as diet changes occur.
  • Framing of TCR delivery as requiring clinician competence in follow-up cadence, risk recognition, and coordinated support.

Closing recommendations (as stated)

  • Primary care requirements to optimize insulin resistance management:
    • GP re-education focused on insulin resistance and metabolic disease.
    • Nurse capability development in data skills, education delivery, and behavior-change support.
    • Inclusion of allied health/therapy support and age-/health-appropriate strength training as part of comprehensive care.