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Bridging the primary-secondary care interface: A model for diabetes care

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Bridging the primary-secondary care interface: A model for diabetes care

Integrated primary and secondary care support programme for diabetics piloted in West Nottingham.

Author: P. Clarke, P. Jacklin and S. R. Page
Journal: Diabetic Medicine  2011  28  ((Clarke, Jacklin) Nottingham West Consortium, Nottingham, United Kingdom)  145-146
Year:  2011

Aims: Nottingham West Consortium (NWC) comprised 13 general practitioner (GP) practices serving 95,000 patients. In 2008 NWC commissioned a diabetes specialist nurse (DSN, 0.7 wte) to enhance community diabetes services supported by a general practitioner (GP) lead and diabetes consultant (0.5 PA).

Methods: Patients from NWC practices attending Nottingham University Hospital (NUH) were identified using the diabetes database. Batched case summaries were sent to practices: discharge from secondary care occurred only after agreement between the patient, their GP and the hospital consultant. Discharged patients were seen in practice-based clinics.

Practice teams undertook annual reviews; the community DSN supported injectable therapies in part or wholly according to individual practice skill levels.Governancewas ensured by weekly meetings between the DSN and consultant; three monthly service review with the GP lead, DSN and consultant; six monthly educationalmeetings for practice staff; and a 12 monthly local primary care trust service review.

Results: Six hundred and forty-five patients attended NUH at project initiation. ByOctober 2010, 234 patients had been discharged.HbA1c (8.41 vs. 8.34 per cent) and per cent blood pressure <145/85 (80 vs. 87 per cent) before and 1 year after discharge were similar. Process measures (smoking status, complications screening) were similar but cholesterol <5 mmol/l was slightly reduced (88 vs. 81 per cent). In the first 18 months the DSN started injectable therapies in 59 patients (20 qinsulin, 39 GLP-1 analogues). Diabetes clinical satisfaction questionnaires confirmed enhanced patient satisfaction with the new service.

Conclusion: Integration of primary and secondary care diabetes services can facilitate safe patient discharge and a reduction in referrals for initiation of injectable therapies.

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