Diabetes in Care Homes

Dunning, Trisha; Sinclair, Alan J.

doi:10.1002/9780470744093.ch22

Cited by 10 publications

(4 citation statements)

References 59 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…The other important groups were the house bound, those with comorbidities or those in palliative care. It was interesting to note that, when compared with the control group, comorbidities alone did not affect access until it was associated with dependency,25 and it is clear that such patients require an individualised care plan 26.…”

Section: Discussionmentioning

confidence: 99%

A case control study of use of the Failed Access Score for determination of failed access to structured diabetes care: the WICKED project

et al. 2014

View full text Add to dashboard Cite

Failure of access to structured diabetes care is associated with adverse outcome. There is no known validated data tool to identify access failure and thus we have developed a Failed Access Score (FAS) and have examined its associations.The FAS is part of the WICKED project (Wolverhampton Interface Care, Knowledge Empowered Diabetes), and consists of three key care processes in diabetes: namely HbA1c, urinary albumin:creatinine ratio and retinal screening. A retrospective case control study in a single GP practice was undertaken on all the patients (n=478) failing two or more parameters over 15 months. They were compared to those with no access failure matched for age, gender, ethnicity and type of diabetes.Among the 51 cases with a FAS ≥2, two or three process measures were absent in 84% and 16% respectively. Excluding service failure, this was due to non-attendance in 35% but otherwise associated with other clinical constraints in 41% (mental health, house bound, palliative care, multi-morbidity) and their deprivation index was significantly higher (p<0.01). Extrapolating to the whole health economy (n=16 644), 2362 (14%) would have a FAS of ≥2 of whom 968 (6%) would have failed access in association with these constraints.In conclusion, it is possible to identify people who are failing access to structured diabetes care using readily available data calculated as the FAS score. Failed access is not usually due to patient default or disengagement but rather, in almost 65%, either due to significant clinical disadvantage or pure failure of service. The objective of this study is to determine whether this score identifies access failure that can be attributed to identifiable factors among individuals with diabetes. Methods The Failed Access ScoreThe FAS consists of three key care processes in diabetes: namely HbA1c, urinary albumin:creatinine ratio (ACR) and retinal screening. This maps to all domains of diabetes care processes in the form of: a blood test (HbA1c) -meaning that all blood tests could have been done; a urine test (ACR) -meaning that the patient attended a clinical appointment so that all clinical measures could have been completed; and a retinal screening testconfirming that the patients are in receipt of communication and able to engage in self-care. Each of these parameters is universally captured in the central database wherever undertaken, whereas others may not be (e.g. weight, blood pressure etc). Completion of all three processes is indicative that the patient has access to the service and engaged to the extent that enough opportunity existed for the health services to complete all nine key care processes in diabetes. Failure of any one parameter over the preceding 15 months was scored 1. A score of zero meant that all three parameters were completed, while a score of 3 meant maximal failure of access such that none of the three parameters were completed and there was no access to the service. Study sampleThe study was undertaken in a single, large inner city GP practice. A retrospect...

show abstract

Section: Discussionmentioning

confidence: 99%

A case control study of use of the Failed Access Score for determination of failed access to structured diabetes care: the WICKED project

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Cabe aquí hacer alusió n al problema de la hipoglucemia en los ancianos ingresados en residencias, pacientes en los que su baja expectativa de vida total y activa desaconsejan formalmente abordajes terapé uticos agresivos, incluyendo un control estricto de la glucemia 16,17 . Entre los factores favorecedores de hipoglucemias en estos pacientes destaca el dé ficit nutricional y la pé rdida de peso, el deterioro cognitivo, la hiporexia que acompañ a a la enfermedad grave y al síndrome de fragilidad habitual en estos pacientes 18,19 , y la falta de reconocimiento de los síntomas (o sus dificultades para comunicarlo).…”

Section: Factores Predisponentes Al Desarrollo De Hipoglucemiaunclassified

Hipoglucemia en ancianos con diabetes

Arambarri

Rodríguez‐Mañas

2012

Medicina Clínica

View full text Add to dashboard Cite

“…[3][4][5] They are characterised by a high prevalence of vascular disease, repeated chest, urine and skin infections, and may be nutritionally impaired. [6][7] There has been a lack of clarity about aims and goals of care and an overemphasis on possibly inappropriate metabolic targets, rather than prioritising resident's quality of life and well-being. More recently, Diabetes UK has produced guidance in this area.…”

Section: Introductionmentioning

confidence: 99%

“…Despite their significant numbers, residents of care homes are a vulnerable and often neglected group of subjects with diabetes lacking comprehensive assessment, monitoring, and specialist access 3-5. They are characterised by a high prevalence of vascular disease, repeated chest, urine and skin infections, and may be nutritionally impaired 6-7. There has been a lack of clarity about aims and goals of care and an overemphasis on possibly inappropriate metabolic targets, rather than prioritising resident’s quality of life and well-being.…”

Section: Introductionmentioning

confidence: 99%

Diabetes in care homes: a cluster randomised controlled trial of resident education

Sinclair

Girling

Gadsby

et al. 2012

Diabetes & Vascular Disease

View full text Add to dashboard Cite

IntroductionResidents of care homes with diabetes are a vulnerable group, lacking comprehensive assessment, monitoring, and specialist access. This study aimed to determine whether a short-term patient centred intervention strategy might benefit people with diabetes living in residential care homes. MethodsResidents with diabetes were recruited and randomised (by care home) to intervention (25 homes: 57 residents) or control (26 homes: 45 residents). The intervention consisted of a medical review and individualised resident educational programme. The control group received usual care. Measures of glycaemic control (fasting glucose and HbA 1c ), quality of life, functional ability, cognition, mood, and diabetes knowledge were collected at baseline and after 6 months. ResultsAfter 6 months the intervention group, compared with control, had better quality of life, mood and diabetes knowledge and a slight increase in HbA 1c from a mean value of 6.84 % (1.54) to 7.49 % (1.82). Reports of hypoglycaemia were less at the end of the study in both groups. ConclusionsThe intervention improved patient-centred outcomes, with a small effect on glycaemic control. More research needs to be performed with care home residents to develop the evidence base for appropriate interventions in this neglected group of patients. Br J Diabetes Vasc Dis 2012;12:238-242.

show abstract

Diabetes in Care Homes

Cited by 10 publications

References 59 publications

A case control study of use of the Failed Access Score for determination of failed access to structured diabetes care: the WICKED project

A case control study of use of the Failed Access Score for determination of failed access to structured diabetes care: the WICKED project

Hipoglucemia en ancianos con diabetes

Diabetes in care homes: a cluster randomised controlled trial of resident education

Contact Info

Product

Resources

About