Service user and community clinician design of a partially virtual diabetic service improves access to care and education and reduces amputation incidence

Abstract

IntroductionDesign of an integrated diabetes service based on needs of service users (persons living with diabetes) and community clinicians in a semirural low-income health district of the UK.Research design and methodsOne hundred and eighty-five service users engaged through public meetings, questionnaires and focus groups. General practice staff contributed views through workshops and questionnaires. Analysis of feedback indicated service user needs for better access to education, dietary advice and foot care. General practice staff endorsed these views and requested regular access to secondary care in the community. Seven hundred persons registered with diabetes attended eight well-being events in the community. From 2017 virtual practice multidisciplinary patient reviews, virtual referral of foot cases and non-face-to-face helplines were developed. A National Health Service (NHS) approved ‘App’ and web-based personalized education support for those recently diagnosed with diabetes was introduced.ResultsEngagement in education for those recently diagnosed with diabetes increased from 5% to 71%. Weight and hemoglobin A1c (HbA1c) levels before and 6 months after starting the program were 99.4±25 and 95.5±24.2 kg and 59.3±16 and 54.8±12.9 mmol/mol, respectively, p=0.00003 and 0.003. Of those engaging at well-being events, 44 had missed regular follow-up. One hundred and seventy-five cases were reviewed virtually with practice staff by the secondary care team avoiding referral to the hospital diabetic clinic. One hundred and seventy-six referrals were made to the virtual multidisciplinary diabetic foot team clinic. Major amputation incidence declined from 13 to 3 major procedures/10 000 per annum and minor amputation from 26 to 18/10 000. Percentage bed day occupancy by persons with diabetes fell significantly in the district general hospital.ConclusionsIntegrated community-based diabetes care delivery has been achieved with partially virtual reviews. Patient education, secondary care in the community, access to dietetic advice and foot care outcomes have all improved.

Effects of educational technologies on the prevention and treatment of diabetic ulcers: A systematic review and meta-analysis

“…An integrated care project, which included timely referral, weekly virtual clinic, healthy lifestyle support, community nurse training, app delivery and personalized educational support, increased engagement in education from 5% to 71% of those newly diagnosed with diabetes mellitus , in addition to reducing the incidence of major amputations from 13 to three procedures per 10,000 patients a year and of minor amputations from 26 to 18 procedures per 10,000 patients a year. This care model also significantly reduced the daily occupation of beds by people with diabetes mellitus in a district general hospital ( 36 ) . In line with this systematic review, when associated with better structuring of the care network and professional training, educational technologies are more effective in reducing foot amputations and hospitalization due to complications arising from diabetes mellitus .…”

Patient‐perceived and practitioner‐perceived barriers to accessing foot care services for people with diabetes mellitus: a systematic literature review

“…Improving patient engagement through health education and availability of information can be achieved through innovative technology (i.e., apps, telemedicine, and social media) that promote patient empowerment and knowledge about their condition. Improving patient engagement in foot care services through the use of technology has been shown to successfully reduce amputation rates in people with diabetes [37]. Although many global frameworks exist for effective interdisciplinary management of the patient with diabetes, they are not widely understood or utilized [38].…”

Peningkatan Pengetahuan tentang Cara Melakukan Latihan Fisik atau Olah Raga yang Aman Bagi Penderita Diabetes Mellitus

“…Pendekatan dengan interaksi sosial dan merubah perilaku membiasakan melakukan aktivitas fisik, mampu meningkatkan kualitas kesehatan para penderita DM (Deng & Liu, 2020). Bahkan, laporan kegiatan di komunitas melaporkan terjadi peningkatan pengetahuan pasien DM tentang perilaku sehat sehingga tercapai kualitas hidup yang lebih baik serta mengurangi resiko amputasi pada pasien ulkus diabetikus (Watt et al, 2021).…”