[ Diabetes Solutions ]

Patient-centred diabetes care

Obesity is increasing rapidly in both developed and developing countries. Legal duty Information on hypoglycaemia, hyperglycaemia, stress and communication are also included. All information in the folder is independent based information and not commercially produced. Only 10% of cases are Type I diabetes and the other 90% are Type II. Over a three year period, diabetes action now will: work to achieve a major increase in awareness about diabetes, its complications, and its prevention, particularly among health policy makers in low- and middle-income countries and communities; initiate and support projects to generate and widely disseminate new knowledge on awareness about diabetes and its economic impact in low- and middle-income communities; produce and widely disseminate a new scientifically-based review on the prevention of diabetes and the complications of diabetes; produce up-to-date, practical guidance for policy makers in low- and middle-income countries, on the contents, structure and implementation of national diabetes programmes; and provide and maintain a web-based resource to help policy makers implement national diabetes programmes. It is estimated that well over half of all cases of type 2 diabetes could be avoided if excessive weight gain in adults could be prevented. DSME is a Medicare-reimbursable service when provided by an accredited program.

They will also send copies to the GP practices that have helped them with the research. Flipchart II contains Part 2 – Nutrition and Activity and Part 3 – Medicines, Monitoring and Reducing Risks. Over the last few decades, modern therapeutic strategies and interdisciplinary, health-promoting services such as patient education have considerably improved the situation of diabetics. The approach to care was based on national diabetes guidelines. Additional training was provided for the intervention group: one and a half days for the nurses and half a day for the doctors. This work will be undertaken in collaboration with other relevant groups within WHO. Other later, support sessions allowed nurses in the intervention group to review their new skills in the light of experience.

Nurses in the control group were offered sessions on the use of guidelines and educational materials. The trial was based in Wessex. Inclusion criteria for the trial sought mid-size practices with 4 medical partners, with list sizes of about 7,000 patients, and a diabetes service registered with the health authority. Diet and exercise also plays an important role in diabetes and it is recommended to make lifestyle changes to positively affect your health status. Teams in the intervention practices had 23 doctors and 32 nurses and teams in the control group 20 and 32 respectively. No attempt was made to ensure that clinicians committed to patient-centred care were in the intervention group. For twelve months nurses reported all newly diagnosed patients to the trial office.

Patients aged 30-70 years were asked to sign consent forms if they were willing to be included in the trial. Criteria were set to exclude certain groups of patients, for example those housebound or mentally ill. A careful approach was taken to measuring outcomes, to establish the baseline situation in the intervention and control groups and to assure the quality of the data collected. Data was collected before the trial started by nurses from clinical notes; year one data was collected by research nurses and summarised at three levels: patient, practitioner and practice level. Diabetes HealthSense. During the trial, the 41 practice teams diagnosed type 2 diabetes in 522 patients of whom 360 were eligible for inclusion in the trial. 250 of these patients completed the study: 142 in the intervention group and 108 in the control group.

Non-respondents were equally distributed across the two groups. All trained nurses who responded (28/32) used the booklet Diabetes in your hands and at the end of the trial 75% of patients in the intervention group recognised it – compared with 2% in the control group. All responding trained nurses (28/32) and doctors (19/23) reported using patient centred consulting with the majority reporting extensive use of the approach. Communications and satisfaction were rated highly by patients in both groups. Patients in the intervention group were more likely to report excellent communications with doctors and greater satisfaction with treatment. Agreement between patients and practitioners on main concerns discussed over the year were similar in both groups. Knowledge scores were significantly lower in the intervention group with differences confined to patients prescribed hypoglycaemic drug treatment.

For lifestyle measures, diet and exercise, the scores were similar in both groups. The results of the clinical measures at one year were encouraging, confirming that patient-centred care can be adopted without loss of glycaemic control. The trial showed some improvements in processes and outcomes but did not achieve the better control of diabetes, healthier lifestyles and knowledge of self-care anticipated. There were no signs that management improved with experience, i.e. Haemoglobin A concentrations among patients in whom type 2 diabetes was diagnosed later in the study were no lower at one year. Moreover, knowledge scores for patients were lower and weight and other cardiovascular risk factors higher among those attending trained practice teams. There are no definitive reasons why more improvements were not achieved – but the report of the study offers several possible reasons.

For example, was the study underpowered to detect the small differences in blood glucose concentrations achievable one-year after diagnosis? This is an interesting study that is refreshingly frank: too few studies that have minimal or little effect tend to be well reported. It has shown the power of the consultation to affect patients’ health and well being. But there are clear signals to remind clinicians committed to the benefits of patient-centred care that they should not loose the essential focus on the disease while paying attention to the unique needs of the individual patient.

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