Improvements in clinical diabetes care in the first year of the new General Medical Services contract in the UK

Jaiveer, Pachaiappan K; Jaiveer, Saraswathy; Jujjavarapu, Sagar B; Morrissey, J; White, J. K.; Gadsby, Roger; Patel, Vinod

doi:10.1177/14746514060060010601

Cited by 3 publications

(4 citation statements)

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“…Notably, the introduction of the 2003 National Service Framework in the UK [1] engendered a culture supportive of patient empowerment and skills-based training. The implementation of the General Medical Services contract for diabetes in 2004 [2] with material incentives to GPs for target achievement had a direct impact on screening and management of diabetes across a range of domains. NICE Guidance (CG15) set down a detailed set of strategies for improving metabolic management in type 1 DM [3].…”

Section: Introductionmentioning

confidence: 99%

Success Rates in a Diabetes Specialist Nurse-Led Education Programme: Re-setting the Glucostat

Heald

Anderson

Khan³

et al. 2016

Exp Clin Endocrinol Diabetes

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Analysis of National Diabetes Audit data from 2011-2012 of newly diagnosed people with type 1 diabetes mellitus (DM) found low initial success rates in much of the UK at 20% on initial training, while an unusually high success rate of 75% achieving target HbA1C<58 mmol/mol (< 7.5%) was found in Cheshire (England average=40.8%). We present a review of the approach taken by the Cheshire Diabetes team in the 12 months following diagnosis. Between 2012 and 2013, 15 consecutive newly diagnosed people with type 1 DM were followed up for 18 months. All received support and advice by community Diabetes Specialist Nurses (DSNs) and Dieticians covering Central and Eastern Cheshire, UK. Mean±SD age at diagnosis was 23±3 years. The period of contact with the DSN service varied from 7-12 weeks. Baseline HbA1C of 99 mmol/mol [11.2%] (95% CI: 86-111 mmol/mol [10.0-12.3%]) declined by ~50% to 49 mmol/mol [6.6%] (41-57 mmol/mol [5.9-7.4%]; F=16.9, p<0.001) at 6 months and did not change between 6-12 months. Of those newly diagnosed with type 1 DM, 84.6% achieved a target HbA1C<58 mmol/mol (<7.5%) and 61.5% met a target<48 mmol/mol (<6.5%). There was no significant weight change during the study. The key elements of this bio-psycho-social approach by the DSN team included providing psychological support, patient engagement, demonstrating positive regard, gaining trust, identifying health-seeking behaviour, providing key decision-making skills and developing a self-management plan. This resulted in improvements in overall glycaemic control well above the national average without untoward weight gain. The UK National Diabetes Audit (2011-2012) in newly diagnosed type 1 diabetics in Cheshire, UK, showed a success rate at 6 months post-diagnosis of 75% achieving a target HbA1C<58 mmol/mol (<7.5%) compared with the national average of 40.8%. Initially thought to be erroneous, these excellent results were confirmed. The approach taken to achieve them is herein described.

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Section: Introductionmentioning

confidence: 99%

Success Rates in a Diabetes Specialist Nurse-Led Education Programme: Re-setting the Glucostat

Heald

Anderson

Khan³

et al. 2016

Exp Clin Endocrinol Diabetes

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“…The Alphabet Strategy is simple but effective mnemonic-based approach which reminds the patients and healthcare professionals of the important components of diabetes care. [7][8][9]15 • UK studies show that we are failing to achieve high standards of care for young adults with type 1 diabetes • The Alphabet Strategy is a mnemonic-based approach which reminds healthcare professional and patients of the important components of diabetes care…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Alphabet Strategy and standards of care in young adults with type 1 diabetes

Gholap

Pillai

Virmani³

et al. 2006

Diabetes & Vascular Disease

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T he Alphabet Strategy is a mnemonic-based approach to assist commitment to important aspects of diabetes care: Advice; Blood pressure lowering; Cholesterol and creatinine control; Diabetes control; Eye examination; Foot examination; and use of Guardian drugs. This strategy reported high standards of care of patients with type 2 diabetes. This study assesses the impact of the Alphabet Strategy on diabetes management in young adults with type 1 diabetes and compared data with those of a recently published multicentre study. Results were analysed using the chi-square test and Student's t-test.Data were collected retrospectively from 68 patients with type 1 diabetes aged 16-25 years attending the George Eliot Hospital (GEH) adolescent diabetes clinic and who were being managed as per The Alphabet Strategy.Standards of diabetes care in the GEH clinic were better than those reported in the multicentre study. GEH versus multicentre study: clinic non-attendance 12% vs. 24.6%: mean HbA 1C % 8.4 vs. 9.5, p<0.001: screening rates; hypertension 100% vs. 88%, p<0.05; nephropathy 80% vs. 56%, p<0.01; retinopathy 98% in GEH clinic: prevalence of complications; nephropathy 5% vs. 21%, p<0.02; retinopathy 24% vs. 28%, not significant.In conclusion, we found regular clinic visits and separate adolescent clinics improve glycaemic control. The Alphabet Strategy may be considered an effective approach in monitoring/screening and attaining targets in young adults with type 1 diabetes. Br J Diabetes Vasc Dis 2006;6:168-70

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“…It has been successfully implemented in the diabetes clinics at a District General Hospital in the UK (George Eliot Hospital, Nuneaton) where it has resulted in high quality diabetes care evidenced by its clinical effectiveness evaluation [ 12 ] and as reflected in the UK Quality and Outcomes Framework (QOF) scores from general practice surgeries using the checklist [ 13 ]. It has also been shown to be an effective tool in achieving randomised clinical trial standards in routine clinical practice [ 14 ].…”

Section: Introductionmentioning

confidence: 99%

Quality of diabetes care worldwide and feasibility of implementation of the Alphabet Strategy: GAIA project (Global Alphabet Strategy Implementation Audit)

Lee

Saravanan

Varadhan

et al. 2014

BMC Health Serv Res

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BackgroundThe Alphabet Strategy (AS) is a diabetes care checklist ensuring “important, simple things are done right all the time.” Current audits of diabetes care in developed countries reveal wide variations in quality with performance of care processes frequently sub-optimal. This study had three components: an audit to assess diabetes care quality worldwide,a questionnaire study seeking opinions on the merits of the AS,a pilot study to assess the practicality of implementation of the AS in a low socioeconomic setting.MethodsAudit data was collected from 52 centres across 32 countries. Data from 4537 patients were converted to Quality and Outcome Framework (QOF) scores to enable inter-centre comparison. These were compared to each country’s Gross Domestic Product (GDP), and Total Health Expenditure percentage per capita (THE%). The opinions of diabetes patients and healthcare professionals from the diabetes care team at each of these centres were sought through a structured questionnaire. A retrospective audit on 100 randomly selected case notes was conducted prior to AS implementation in a diabetes outpatient clinic in India, followed by a prospective audit after four months to assess its impact on care quality.ResultsQOF scores showed wide variation across the centres (mean 49.0, range 10.2–90.1). Although there was a positive relationship between GDP and THE% to QOF scores, there were exceptions. 91% of healthcare professionals felt the AS approach was practical. Patients found the checklist to be a useful education tool. Significant improvements in several aspects of care as well as 36% improvement in QOF score were seen following implementation.ConclusionsInternational centres observed large variations in care quality, with standards frequently sub-optimal. 71% of health care professionals would consider adopting the AS in their daily practice. Implementation in a low resource country resulted in significant improvements in some aspects of diabetes care. The AS checklist for diabetes care is a freely available in the public domain encompassing patient education, care plans, and educational resources for healthcare professionals including summary guidelines. The AS may provide a unique approach in delivering high quality diabetes care in countries with limited resources.Electronic supplementary materialThe online version of this article (doi:10.1186/1472-6963-14-467) contains supplementary material, which is available to authorized users.

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Improvements in clinical diabetes care in the first year of the new General Medical Services contract in the UK

Cited by 3 publications

References 20 publications

Success Rates in a Diabetes Specialist Nurse-Led Education Programme: Re-setting the Glucostat

Success Rates in a Diabetes Specialist Nurse-Led Education Programme: Re-setting the Glucostat

The Alphabet Strategy and standards of care in young adults with type 1 diabetes

Quality of diabetes care worldwide and feasibility of implementation of the Alphabet Strategy: GAIA project (Global Alphabet Strategy Implementation Audit)

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