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Community Diabetes Care the hospital view Dr Prakash Abraham.
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Transcript of Community Diabetes Care the hospital view Dr Prakash Abraham.
![Page 1: Community Diabetes Care the hospital view Dr Prakash Abraham.](https://reader035.fdocuments.us/reader035/viewer/2022062716/56649dd15503460f94ac7853/html5/thumbnails/1.jpg)
Community Diabetes Carethe hospital view
Dr Prakash Abraham
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• How many practices here?
• How many run diabetes clinics?
• What proportion of patients with diabetes come there?
• What are the barriers for taking this on?
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Projected Prevalence of Diabetes Mellitus in UK
2001 2010 2030
1.5m
3.0m
6.0m
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Grampian Prevalance
• Approaching 4%
• Over 19,500 patients with diabetes (April 2006)
• 12000 in April 2002
• 10,000 attendances at diabetes clinic
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Need for integrated care
• Two 30 minute review appointments for 19,500 patients per year. 19,500hours
• 44 weeks work/year: 444 hours per week• Each clinic ~4 hours: 110 clinics a week
supervised by 3 WTE consultant diabetologists (Associate Specialists/Clinical assistants/SPRs).
• 10 clinics per week by permanent staff• ~10 Trainee run clinics
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Treatment Distributions
Insulin On Insulin 694 23Not on Insulin 2157 77
Type Type I 427 15Type II - Insulin 282 10Type II - Tablets 815 22Type II - Diet 803 29Type II - Tablets & Diet 520 25
Over 75% not on insulin Initial & realistic target for transfer of care
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Diabetic Population: Banff & Buchan
• 1999 1678
–1.9% of population
• 2005 2876–3.6% of population
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Place of Care
Practice Only Care
34
5565
76
0
10
20
30
40
50
60
70
80
%
2001 2003 2004 2005
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Place of Care
Hospital Only Care
30
24
18
11
0
10
20
30
40
%
2001 2003 2004 2005
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Care Parameters Improved
8.37.6
9399
47
62
9598
70
89
0
10
20
30
40
50
60
70
80
90
100
percent
HbA1c HbCheck BP<140/80
BP check PN Foot
2001
2005
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Patients and Staff FeedbackWhat are the benefits of being seen at your Practice?
Total %Convenience 156 89Accessibility 90 51Continuity 77 44Familiarity 112 64Other 5 3
Total %1 4 32 73 493 18 124 46 31More than 4 7 5
How often do you attend your Practice for Diabetic Care in one year?
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Which professionals did you see at your diabetic review today?
Total %Practice Nurse 152 88Practice Nurse and GP 14 8GP 1 1Other 5 3
Total %Yes 148 87No 22 13
Did you attend your Practice to have bloods taken before today’s diabetes review?
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With all this patient exchange what does the hospital doctor
do?
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What does the hospital Dr do?
• Golf• Hill walking• But still
– about 10000 patients attending annually– More complex patients (higher proportion of
the 25% that need more time)– To see with same time as in practice clinics– 28 clinics per week (still running at > twice the
capacity)
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Woolmanhill attendances
0
2000
4000
6000
8000
10000
12000
14000
16000
1999 2000 2001 2002 2003 2004
New
Return
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What does the hospital Dr do?
• Release of hospital resources to focus on complicated cases
• Develop services– Adolescent care– Pregnancy care– Foot/Renal– Insulin Pump
• Guidelines & Protocol development
• Teaching/Training/Research
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Integrated care: Building blocks 1
• Enthusiastic team• Multidisciplinary leadership
– GP– DSN– Dietitian– Podiatry– Patient– Management Representative– Secondary care link
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Building blocks 2
• Agreed Criteria• Agreed standards• Empowerment: Staff/Patients• IT Support/Audit• Education at all levels
– GPs: Lilly course– All(Warwick, Shipley, Insulin for life)– Ongoing education/ Courses /Conferences /
Network days
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Incentives for transfer
• Better patient care
• Satisfied patient and staff
• Easier access & better service for the 25% who need more input
• Higher GP contract Quality points
• Clinical Accord
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GP contract
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GP Contract 2004/5~90/99 Points (including
all 56 previous points)LHCC AVERAGES - Q & O FRAMEWORK
Diabetes Q & O Framework
1 100% 10 84%
2 94% 11 97%
3 98% 12 62%
4 79% 13 77%
5 98% 14 77%
6 54% 15 51%
7 85% 16 88%
8 82% 17 50%
9 84% 18 74%
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Wishlist
• Dedicated time for– Telephone session with practices– Teleconferencing
• Practice education visits
• Redesign of secondary care to deliver better care of diabetes complications
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Primary & secondary care work in partnership with the
patient at the centre