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Community Diabetes Care the hospital view

Community Diabetes Care the hospital view. Dr Prakash Abraham. 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?. Projected Prevalence of Diabetes Mellitus in UK. 2001 2010 2030.

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Community Diabetes Care the hospital view

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  1. Community Diabetes Carethe hospital view Dr Prakash Abraham

  2. 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?

  3. Projected Prevalence of Diabetes Mellitus in UK 2001 2010 2030 6.0m 3.0m 1.5m

  4. Grampian Prevalance • Approaching 4% • Over 19,500 patients with diabetes (April 2006) • 12000 in April 2002 • 10,000 attendances at diabetes clinic

  5. 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

  6. Treatment Distributions Over 75% not on insulin Initial & realistic target for transfer of care

  7. Diabetic Population: Banff & Buchan • 1999 1678 • 1.9% of population • 2005 2876 • 3.6% of population

  8. Place of CarePractice Only Care

  9. Place of CareHospital Only Care

  10. Care Parameters Improved

  11. Patients and Staff Feedback

  12. With all this patient exchange what does the hospital doctor do?

  13. 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)

  14. Woolmanhill attendances

  15. 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

  16. Integrated care: Building blocks 1 • Enthusiastic team • Multidisciplinary leadership • GP • DSN • Dietitian • Podiatry • Patient • Management Representative • Secondary care link

  17. 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

  18. 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

  19. GP contract

  20. GP Contract 2004/5~90/99 Points (including all 56 previous points)

  21. Wishlist • Dedicated time for • Telephone session with practices • Teleconferencing • Practice education visits • Redesign of secondary care to deliver better care of diabetes complications

  22. Primary & secondary care work in partnership with the patient at the centre

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