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Patel S, Farkash C, Simmons D. Type 1 diabetes management and hospitalisation in the over 25's at an Australian outer urban diabetes clinic. BMC Endocr Disord 2022; 22:143. [PMID: 35641973 PMCID: PMC9158186 DOI: 10.1186/s12902-022-01057-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 05/25/2022] [Indexed: 11/10/2022] Open
Abstract
AIMS To describe clinic management and referral pathways among adults with type 1 diabetes (T1D) aged > 25 years attending a public outpatient diabetes service. METHODS Retrospective cohort study of people with T1D aged > 25 years seen by endocrinologists in one Australian urban public outpatient in 2017. Electronic and paper medical records were reviewed using a dataset adapted from the UK National Institute for Health and Care Excellence 2015 guidelines. RESULTS Among the 111 people with T1D (mean age 41 ± 13 years, 55% men, mean body mass index 27.1 ± 5.6 kg/m2), mean HbA1c was 8.1 ± 1.9% (66 ± 19 mmol/mol) (lower than the Australian National Diabetes Audit: 8.5%/69 mmol/mol) with 25.5% meeting the guideline target of < 53 mmol/mol (7.0%). Most people had seen a diabetes educator (80.2%) or dietitian (73.0%) and had complication screening. Complication rates were high (nephropathy 20.4%, retinopathy 27.4%, peripheral neuropathy 30.1%, ischaemic heart disease/acute infarction 10.5%). Overall, 27% of referrals occurred following an acute inpatient admission or emergency department presentation and 13% for management of diabetes in pregnancy. CONCLUSIONS A high proportion of people with T1D accessed public specialist care either during pregnancy or after a largely avoidable acute glycaemia-related hospital presentation. Subsequent care was in line with national specialist standards. This area has a "wait for acute event" rather than "complication prevention" model of care, associated with under-referral to the local multidisciplinary specialist service. Understanding how widespread this model of care is, and ways to reduce its prevalence, are urgently required.
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Affiliation(s)
- Shivani Patel
- Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia
| | - Celine Farkash
- School of Medicine, Western Sydney University, Campbelltown, NSW, Australia
| | - David Simmons
- Department of Diabetes & Endocrinology, Campbelltown Hospital, Campbelltown, NSW, Australia.
- Macarthur Clinical School, Western Sydney University, Campbelltown, NSW, Australia.
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2
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Zhang Z, Monro J, Venn BJ. Carbohydrate Knowledge and Expectations of Nutritional Support among Five Ethnic Groups Living in New Zealand with Pre- and Type 2 Diabetes: A Qualitative Study. Nutrients 2018; 10:nu10091225. [PMID: 30181471 PMCID: PMC6163622 DOI: 10.3390/nu10091225] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/03/2018] [Accepted: 09/03/2018] [Indexed: 01/29/2023] Open
Abstract
Despite availability of diabetes and nutrition information for people with pre- and type 2 diabetes, the uptake and understanding of these resources may differ among ethnic groups. Our objective was to explore dietary knowledge and diabetes experiences amongst Māori, European, Pacific Island, Indian and East Asian people living in New Zealand with a focus on carbohydrate-containing foods. A registered diabetes dietitian led ethnic-specific discussions in groups involving 29 people with pre- or type 2 diabetes. Discussions were audio-recorded, fully transcribed and coded independently by two investigators. Themes were developed using deductive and inductive techniques. Five themes emerged: knowledge, concerns, achievements, simplicity and self-determination. Nutritional knowledge was lacking and a greater awareness of trustworthy dietary resources was needed. There were concerns about diabetes complications and appropriate carbohydrate-containing foods and portions. Contrary to this, people felt proud when achieving dietary goals and grateful for support from health care providers and family. Participants were willing to engage in self-care if advice from health professionals was given in plain language, and in a culturally appropriate manner. Given the desire to take an active role in diabetes self-management and willingness to use electronic devices, an ethnic-specific nutrition education resource could be a valuable tool.
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Affiliation(s)
- Zhuoshi Zhang
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
| | - John Monro
- New Zealand Institute for Plant & Food Research Ltd., Private Bag 11600, Palmerston North 4442, New Zealand.
| | - Bernard J Venn
- Department of Human Nutrition, University of Otago, PO Box 56, Dunedin 9054, New Zealand.
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3
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MacDonald Werstuck M, Buccino J. Dietetic Staffing and Workforce Capacity Planning in Primary Health Care. CAN J DIET PRACT RES 2018; 79:181-185. [PMID: 30014721 DOI: 10.3148/cjdpr-2018-018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
The addition of Registered Dietitians (RD) to primary health care (PHC) teams has been shown to be effective in improving health and economic outcomes with reported savings of $5 to $99 New Zealand dollars for every $1 spent on nutrition interventions. Despite proven benefits, very few Canadians have access to dietitians in PHC. This paper summarizes the literature on dietetic staffing ratios in PHC in Canada and other countries with similar PHC systems. Examples are shared to demonstrate how dietitians and others can utilize published staffing ratios to review dietitian services within their settings, identify gaps, and advocate for additional positions to meet population needs. The majority of published dietetic staffing ratios describe ranges of 1 RD: 15 000-18 500 patients, 1 RD for every 4-14 family physicians, or 1 RD for every 300-500 patients with diabetes. These staffing ratios may be inadequate as surveys report ongoing issues of limited access to dietetic counseling, under-serviced populations, and a shortage of dietitians to meet current population needs in PHC. Newer projection models based on specific population needs and ongoing workforce data are required to identify professional practice issues and accurately estimate dietetic staffing requirements in PHC.
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Affiliation(s)
- Michele MacDonald Werstuck
- a Hamilton Family Health Team, Hamilton, ON.,b Department of Family Medicine, McMaster University, Hamilton, ON.,c Dietitians of Canada Primary Health Care Action Group
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4
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Bonora E, Monami M, Bruno G, Zoppini G, Mannucci E. Attending Diabetes Clinics is associated with a lower all-cause mortality. A meta-analysis of observational studies performed in Italy. Nutr Metab Cardiovasc Dis 2018; 28:431-435. [PMID: 29627120 DOI: 10.1016/j.numecd.2018.02.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2017] [Revised: 01/28/2018] [Accepted: 02/19/2018] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The epidemiological explosion of diabetes is a challenge for Health Systems and the identification of the most appropriate models of care are warranted. The inclusion of primary care physicians in the models is unquestioned whereas the role played by secondary and tertiary care (Diabetes Clinic) is often debated. However, studies focusing on hard endpoints and comparing Diabetes Clinic attendance vs. no attendance are scant. RESEARCH DESIGN AND METHODS A meta-analysis was performed including all observational cohort studies performed in Italy, reporting crude and/or adjusted estimates of all-cause mortality in patients with diabetes attending or not attending Diabetes Clinics. Attendance was defined by prescriptions and reimbursement of specialist visits by the National Health System. RESULTS Three studies enrolling 191,847 subjects with diabetes were included in the analysis, and about half of them had at least one visit in the Diabetes Clinic per year. During the follow-up, ranging 1-11 years, 9653 subjects died. Mortality was remarkably lower in subjects attending Diabetes Clinic (MH-OR 0.70, 95% CI 0.55-0.88, p = 0.002). Results were confirmed after adjusting for confounders (MH-OR 0.81, 95% CI 0.69-0.95, p = 0.009). CONCLUSIONS The results of the present study suggest that attending Diabetes Clinics is associated with a lower all-cause mortality. This finding might be instrumental to implement the best models of care for persons with diabetes.
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Affiliation(s)
- E Bonora
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy.
| | - M Monami
- Diabetology, Azienda Ospedaliera Careggi and University of Florence, Italy
| | - G Bruno
- Department of Medical Sciences, University of Turin, Turin, Italy
| | - G Zoppini
- Division of Endocrinology, Diabetes and Metabolism, University and Hospital Trust of Verona, Verona, Italy
| | - E Mannucci
- Diabetology, Azienda Ospedaliera Careggi and University of Florence, Italy
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5
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Riordan F, McHugh SM, Murphy K, Barrett J, Kearney PM. The role of nurse specialists in the delivery of integrated diabetes care: a cross-sectional survey of diabetes nurse specialist services. BMJ Open 2017; 7:e015049. [PMID: 28801394 PMCID: PMC5724109 DOI: 10.1136/bmjopen-2016-015049] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
OBJECTIVES International evidence suggests the diabetes nurse specialist (DNS) has a key role in supporting integrated management of diabetes. We examine whether hospital and community DNS currently support the integration of care, examine regional variation in aspects of the service relevant to the delivery of integrated care and identify barriers to service delivery and areas for improvement. DESIGN A cross-sectional survey of hospital and community-based DNS in Ireland. METHODS Between September 2015 and April 2016, a 67-item online survey, comprising closed and open questions on their clinical role, diabetes clinics, multidisciplinary working, and barriers and facilitators to service delivery, was administered to all eligible DNS (n=152) in Ireland. DNS were excluded if they were retired or on maternity leave or extended leave. RESULTS The response rate was 66.4% (n=101): 60.6% (n=74) and 89.3% (n=25) among hospital and community DNS, respectively. Most DNS had patients with stable (81.8%) and complicated type 2 diabetes mellitus (89.9%) attending their service. The majority were delivering nurse-led clinics (81.1%). Almost all DNS had a role liaising with (91%), and providing support and education to (95%), other professionals. However, only a third reported that there was local agreement on how their service should operate between the hospital and primary care. Barriers to service delivery that were experienced by DNS included deficits in the availability of specialist staff (allied health professionals, endocrinologists and DNS), insufficient space for clinics, structured education and issues with integration. CONCLUSIONS Delivering integrated diabetes care through a nurse specialist-led approach requires that wider service issues, including regional disparities in access to specialist resources and formalising agreements and protocols on multidisciplinary working between settings, be explicitly addressed.
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Affiliation(s)
- Fiona Riordan
- Department of Epidemiology and Public Health, University College Cork National University of Ireland, Cork, Ireland
| | - Sheena M McHugh
- Department of Epidemiology and Public Health, University College Cork National University of Ireland, Cork, Ireland
| | - Katie Murphy
- Department of General Practice, University College Cork, Cork, Ireland
| | - Julie Barrett
- Department of Epidemiology and Public Health, University College Cork National University of Ireland, Cork, Ireland
| | - Patricia M Kearney
- Department of Epidemiology and Public Health, University College Cork National University of Ireland, Cork, Ireland
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6
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Developing the Job Description for Diabetes Nurse Specialists: A Modified Delphi Approach. Nurs Midwifery Stud 2016. [DOI: 10.5812/nmsjournal.33928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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7
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Goudarzian S, Yamani N, Amini M, Abazari P. Developing the Job Description for Diabetes Nurse Specialists: A Modified Delphi Approach. Nurs Midwifery Stud 2016. [DOI: 10.17795/nmsjournal33928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Manski-Nankervis JA, Furler J, Young D, Patterson E, Blackberry I. Factors associated with relational coordination between health professionals involved in insulin initiation in the general practice setting for people with type 2 diabetes. J Adv Nurs 2015; 71:2176-88. [DOI: 10.1111/jan.12681] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/27/2015] [Indexed: 11/29/2022]
Affiliation(s)
| | - John Furler
- Department of General Practice; University of Melbourne; Carlton Victoria Australia
| | - Doris Young
- Department of General Practice; University of Melbourne; Carlton Victoria Australia
| | - Elizabeth Patterson
- Department of Nursing; Melbourne School of Health Sciences; University of Melbourne; Carlton Victoria Australia
| | - Irene Blackberry
- Department of General Practice; University of Melbourne; Carlton Victoria Australia
- Faculty of Health Sciences; La Trobe University; Wodonga Victoria Australia
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9
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Coates VE, McCann A, Posner N, Gunn K, Seers K. ‘Well, who do I phone?’ Preparing for urgent care: a challenge for patients and service providers alike'. J Clin Nurs 2015; 24:2152-63. [DOI: 10.1111/jocn.12814] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2015] [Indexed: 12/19/2022]
Affiliation(s)
- Vivien E Coates
- Joint Appointment University of Ulster & Western Health and Social Care Trust; Institute of Nursing & Health Research; School of Nursing; University of Ulster; Coleraine UK
| | | | - Natasha Posner
- Warwick Medical School; University of Warwick; Coventry UK
| | - Kathleen Gunn
- Warwick Medical School; University of Warwick; Coventry UK
| | - Kate Seers
- RCN Research Institute; Division of Health Sciences; Warwick Medical School; University of Warwick; Coventry UK
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10
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Manski-Nankervis JA, Blackberry I, Young D, O'Neal D, Patterson E, Furler J. Relational coordination amongst health professionals involved in insulin initiation for people with type 2 diabetes in general practice: an exploratory survey. BMC Health Serv Res 2014; 14:515. [PMID: 25361788 PMCID: PMC4224690 DOI: 10.1186/s12913-014-0515-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 10/13/2014] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The majority of people with type 2 diabetes (T2D) receive their care in general practice and will eventually require initiation of insulin as part of their management. However, this is often delayed and frequently involves referral to specialists. If insulin initiation is to become more frequent and routine within general practice, coordination of care with specialist services may be required. Relational coordination (RC) provides a framework to explore this. The aim of this study was to explore RC between specialist physicians, specialist diabetes nurses (DNEs), generalist physicians in primary care (GPs) and generalist nurses (practice nurses (PNs)) and to explore the association between RC and the initiation of insulin in general practice, and the belief that it is appropriate for this task to be carried out in general practice. METHODS A survey was distributed to a convenience sample of specialist physicians, DNEs, GPs and practice nurses. We collected data on demographics, models of care and RC in relation to insulin initiation. We expected that RC would be higher between specialists than between specialists and generalists. We expected higher RC between specialists and generalists to be associated with insulin initiation in general practice and with the belief that it is appropriate for insulin initiation to be carried out in general practice. We used descriptive statistics and non-parametric tests to explore these hypotheses. RESULTS 179 health professionals returned completed surveys. Specialists reported higher RC with each other and lower RC with PNs. All groups except PNs reported their highest RC with DNEs, suggesting the potential for DNEs to serve as boundary spanners. Lower RC with specialists was reported by those working within a general practice model of care. Health professionals who felt that a general practice model was appropriate reported lower communication with specialist physicians and higher shared knowledge with GPs. CONCLUSION Given the need for coordination between specialist and generalist care for the task of insulin initiation, this study's results suggest the need to build relationships and communication between specialist and generalist health professional groups and the potential for DNE's to play a boundary spanner role in this process.
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11
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Manski-Nankervis JA, Furler J, Blackberry I, Young D, O’Neal D, Patterson E. Roles and relationships between health professionals involved in insulin initiation for people with type 2 diabetes in the general practice setting: a qualitative study drawing on relational coordination theory. BMC FAMILY PRACTICE 2014; 15:20. [PMID: 24479762 PMCID: PMC3909758 DOI: 10.1186/1471-2296-15-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/04/2013] [Accepted: 01/30/2014] [Indexed: 12/14/2022]
Abstract
BACKGROUND The majority of care for people with type 2 diabetes occurs in general practice, however when insulin initiation is required it often does not occur in this setting or in a timely manner and this may have implications for the development of complications. Increased insulin initiation in general practice is an important goal given the increasing prevalence of type 2 diabetes and a relative shortage of specialists. Coordination between primary and secondary care, and between medical and nursing personnel, may be important in achieving this. Relational coordination theory identifies key concepts that underpin effective interprofessional work: communication which is problem solving, timely, accurate and frequent and relationships between professional roles which are characterized by shared goals, shared knowledge and mutual respect. This study explores roles and relationships between health professionals involved in insulin initiation in order to gain an understanding of factors which may impact on this task being carried out in the general practice setting. METHOD 21 general practitioners, practice nurses, diabetes nurse educators and physicians were purposively sampled to participate in a semi-structured interview. Transcripts of the interviews were analysed using framework analysis. RESULTS There were four closely interlinked themes identified which impacted on how health professionals worked together to initiate people with type 2 diabetes on insulin: 1. Ambiguous roles; 2. Uncertain competency and capacity; 3. Varying relationships and communication; and 4. Developing trust and respect. CONCLUSIONS This study has shown that insulin initiation is generally recognised as acceptable in general practice. The role of the DNE and practice nurse in this space and improved communication and relationships between health professionals across organisations and levels of care are factors which need to be addressed to support this clinical work. Relational coordination provides a useful framework for exploring these issues.
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Affiliation(s)
- Jo-Anne Manski-Nankervis
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - John Furler
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - Irene Blackberry
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - Doris Young
- General Practice and Primary Health Care Academic Centre, University of Melbourne, Carlton, Victoria
| | - David O’Neal
- Department of Medicine, St Vincent’s Hospital, Fitzroy, Victoria
| | - Elizabeth Patterson
- Department of Nursing, Melbourne School of Health Sciences, University of Melbourne, Carlton, Victoria
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12
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Russell-Jones EC, Gough A, Lawrence S, Scobie IN. The novel use of commonly captured data to assess a district's diabetes service that encompasses both primary and secondary care. QJM 2013; 106:737-45. [PMID: 23625528 DOI: 10.1093/qjmed/hct097] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
AIM To identify commonly captured data in the UK to look at the performance of a district's diabetes care that encompasses both primary and secondary care. METHODS Primary care quality outcomes framework (QOF) measures for diabetes, referral rates for first appointment for specialist secondary care and emergency admission rates for diabetes (Dr Foster/HES) were used to produce a performance index scoring system. Illustrative measures from QOF were total diabetes points, DM23 attainment of HbA1c <7% (53 mmol/mol) and its exemption rate (number of patients excluded from analysis). The performance index was used to study the effectiveness of the Medway district diabetes service and this was compared to another district (Guildford) within the same Strategic Health Authority and nationally. RESULTS Medway has the highest prevalence of Diabetes (6.1%) of the 8 Primary Care Trusts examined, the lowest achievement of diabetes QOF points (96.1%) and the lowest achievement of an HbA1c level <7% (53 mmol/mol) (54.3%). Exemption reporting was the 3rd highest. SAR for first diabetes out-patient appointment to the hospital was low at 281 (predicted 576) 48% of expected. The emergency admission rate was high at 225 (predicted 168) 133% of expected. Thus primary care diabetes needs to raise performance and implement a lower threshold for OPD referral to prevent emergency admissions. CONCLUSION It is possible to produce an assessment of diabetes care that transcends primary/secondary care that gives a true reflection of a district's performance which will be useful to plan future health service provision.
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Affiliation(s)
- E C Russell-Jones
- King's College London, Academic Centre, First Floor, Henriette Raphael House, Guy's Campus, London SE1 1UL, UK.
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Ozcan S, Rogers H, Choudhary P, Amiel SA, Cox A, Forbes A. Redesigning an intensive insulin service for patients with type 1 diabetes: a patient consultation exercise. Patient Prefer Adherence 2013; 7:471-80. [PMID: 23776329 PMCID: PMC3681326 DOI: 10.2147/ppa.s43338] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
CONTEXT Providing effective support for patients in using insulin effectively is essential for good diabetes care. For that support to be effective it must reflect and attend to the needs of patients. PURPOSE To explore the perspectives of adult type 1 diabetes patients on their current diabetes care in order to generate ideas for creating a new patient centered intensive insulin clinic. METHODS A multi-method approach was used, comprising: an observational exercise of current clinical care; three focus groups (n = 17); and a survey of service users (n = 419) to test the ideas generated from the observational exercise and focus groups (rating 1 to 5 in terms of importance). The ideas generated by the multi-method approach were organized thematically and mapped onto the Chronic Care Model (CCM). RESULTS THE THEMES AND PREFERENCES FOR SERVICE REDESIGN IN RELATION TO CCM COMPONENTS WERE: health care organization, there was an interest in having enhanced systems for sharing clinical information; self-management support, patients would like more flexible and easy to access resources and more help with diabetes technology and psychosocial support; delivery system design and clinical information systems, the need for greater integration of care and better use of clinic time; productive relationships, participants would like more continuity; access to health professionals, patient involvement and care planning. The findings from the patient survey indicate high preferences for most of the areas for service enhancement identified in the focus groups and observational exercise. Clinical feedback and professional continuity (median = 5, interquartile range = 1) were the most highly rated. CONCLUSION The patient consultation process had generated important ideas on how the clinical team and service can improve the care provided. Key areas for service development were: a stronger emphasis of collaborative care planning; improved patient choice in the use of health technology; more resources for self-management support; and a more explicit format for the process of care in the clinic.
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Affiliation(s)
- Seyda Ozcan
- Department of Medical Nursing, Florence Nightingale Nursing Faculty, Istanbul University, Istanbul, Turkey
- Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King’s College London, London, United Kingdom
- Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Correspondence: Seyda Ozcan, Department of Medical Nursing, Florence Nightingale Nursing Faculty, Istanbul University, Abide-i Hurriyet Cad. Sisli, 34381, Istanbul, Turkey, Tel +90 532 164 6717, Email
| | - Helen Rogers
- Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Pratik Choudhary
- Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Stephanie A Amiel
- Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Alison Cox
- Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Angus Forbes
- Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King’s College London, London, United Kingdom
- Department of Diabetes, King’s College Hospital NHS Foundation Trust, London, United Kingdom
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