World of Irish Nursing & Midwifery May 2019


Major deficits in diabetes services D espite the pressure on hospitals and lack of staff, there still appear to be barriers to referring people with uncomplicated type 2 diabetes to primary care

in podiatrists and 19% in specialist diabe- tes nursing staff. Staffing levels The report says that in order to achieve an integrated diabetes model of care, ade- quate staffing levels need to be in place to allow for hospital multidisciplinary teams to manage people with complex diabe- tes, while supporting general practice to deliver a greater amount of routine diabe- tes care to people with uncomplicated type 2 diabetes. In terms of getting an overview of the problem, the report said that setting up a national diabetes register is complicated by the fact that current hospital patient registers and management systems differ and some cannot even generate a list of diabetes patients. In addition, a clinical information system that can track individuals as well as patient populations has been described as a neces- sity when managing chronic illnesses such as diabetes. Only 17 of the 31 diabetes ser- vices reported they could generate a list of diabetes patients. Only four of the 31 diabetes services could provide ‘actual’ fig- ures for the number of patients attending in 2016. Recommendations In relation to type 1 diabetes, the national model recommends that people with type 1 diabetes should be managed in secondary care and seen two to three times per year. Complicated type 2 diabe- tes should be seen at least once a year in secondary care. However, recommendations are not being met by many hospitals, with over half reporting a recall time of more than seven months for adults with uncom- plicated type 1 diabetes and almost a quarter of hospitals reporting a recall time of more than 13 months for people

with type 2 diabetes who are on insulin. Despite the importance of structured patient education for people with type 1 or type 2 diabetes, only 409 adults with type 1 diabetes attended such a programme in 2016, with only 158 having attended a programme which meets interna- tional standards. Hospitals not delivering structured education for type 1 patients identified lack of dietetic support to deliver education as a major issue. On foot care, not all hospitals are meet- ing recommendations made in the updated draft Model of Care for the Diabetic Foot. All nine ‘Model 4’ hospitals reported having a multidisciplinary foot team but not all had access to all the specialties recommended as part of a team. Of the remaining 22 hospital services, findings suggest that over one-third do not have the recommended established foot protec- tion team in place. In addition, it is recommended that obesity surgery should be included as a treatment option for certain people with type 2 diabe- tes. The findings suggest that the numbers referred for bariatric services are small, with an estimated 61-64 patients being referred in the 12 months prior to the survey. Staffing levels, access to structured dia- betes education that meets international standards, better clinical information systems to track diabetes populations, improvements in diabetes foot care and improved access to bariatric services are priority areas that need to be addressed, the report concludes. – Geraldine Meagan Reference 1.O’Donnell M,Smyth N,Dinneen SF on behalf of the National Clinical Programme for Diabetes. National Survey of Diabetes Care Delivery in Acute Hospitals.As accessed on: eng/about/who/cspd/ncps/diabetes/resources/ national-survey-of-diabetes-care-delivery-in-acute- hospitals-2018.pdf

SERIOUS shortcomings in the delivery of diabetes services by Irish hospitals have been highlighted in a recently published survey, which has suggested that there seems to be a reluctance to refer patients with uncomplicated type 2 diabetes back to primary care. The National Model of Integrated Care recommends that those with uncompli- cated type 2 diabetes should be treated in primary care. These patients should be discharged into primary care if they are participating in this model of care. Findings from this survey suggest that many hospitals are still accepting refer- rals for people with uncomplicated type 2 diabetes and the majority of hospitals are not routinely discharging people requiring uncomplicated management with a med- ical card or GP visit card into primary care. According to the report, although many hospitals have agreed to the model in prin- ciple, there was a perception that GPs were reluctant to take these patients. There were also concerns about the level of dia- betes services patients would currently receive in primary care. Concerns The recently published National Survey of Diabetes Care in Acute Hospitals 1 pre- pared on behalf of the National Clinical Programme for Diabetes in 2017, included all 31 public hospitals currently providing diabetes care in Ireland. It drew attention to several areas of concern. The survey highlights understaffing and lack of service availability across Ireland. The current national whole-time equiv- alent of consultant endocrinologists is estimated to be 72% lower than recom- mended minimum levels. Major staffing deficits were also identified across other disciplines, with a national deficit of 95% in psychologists, of 74% in dietitians, 32%

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