A decade of change in diabetes services in a deprived multiethnic inner city area: diabetes in Tower Hamlets

Tahseen A Chowdhury, Bobby Huda

Abstract


Introduction: Diabetes care in deprived multiethnic inner city areas can be challenging. Old models of care need to evolve to take into account demographic change, increasing prevalence of the condition and scarcity of resources.

Strategies for change: A managed clinical network was tasked with implementing the standards of the Diabetes National Service Framework. Working with patients and other stakeholders, the group developed a model of care based around enhanced diabetes care in primary care, with specialist care reserved for more complex patients. Specialist support for primary care clinicians was provided by community-based multidisciplinary team meetings held within each primary care locality (network). Structured programmes for education of patients and health professionals were provided by the specialist team. Subsequently, use of National Diabetes Inpatient Audit (NaDIA) data enabled us to attract additional resources to improve diabetes inpatient care.

Outcomes: Between 2008/9 and 2012/3, completed care plans rose from 10% to 88% and attendances for retinal screening rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤140/80 mmHg and cholesterol ≤4 mmol/L rose from 35.3% to 46.1%, and mean glycated haemoglobin dropped from 62 mmol/mol to 60 mmol/mol (7.80% to 7.66%). Referrals to specialist care fell from 25 per week to six per week. NaDIA data also showed significant improvements in inpatient diabetes outcomes.

Conclusions: Partnership between patients, specialists and primary care to improve diabetes care in multiethnic deprived inner city areas can achieve significant improvements in outcomes. Fundamental to the success of this approach is to hold regular clinical meetings between specialist and primary care clinicians and allow rapid access to support and advice. Patient and health professional education also enables care to be delivered effectively, locally to the patient. Future challenges include managing the ever-growing demands within a shrinking financial envelope and developing prevention measures to reduce the prevalence of diabetes in the area.

Keywords


Diabetes National Service Framework, quality improvement, quality outcomes framework, diabetes education, National Diabetes Inpatient Audit

Full Text:

HTML PDF

References


Diabetes UK. Facts and figures (Dec 2015). https://www.diabetes.org.uk/About_us/What-we-say/Statistics/ (accessed 7 Jan 2016).

Gaede P, Lund-Andersen H, Parving HH, Pedersen O. Effect of a multifactorial intervention on mortality in type 2 diabetes. N Engl J Med 2008;358:580-91. http://dx.doi.org/10.1056/NEJMoa0706245.

Tower Hamlets Borough Profile 2015. http://www.towerhamlets.gov.uk/lgnl/community_and_living/borough_profile/borough_profile.aspx (accessed 7 Jan 2016).

London Health Observatory. Cited January 2013. www.lho.org.uk (accessed 7 Jan 2016).

Chowdhury TA, Lasker SS, Mahfuz R. Ethnic differences in control of cardiovascular risk factors in patients with type 2 diabetes attending an Inner London diabetes clinic. Postgrad Med J 2006;82:211-15. https://doi.org/10.1136/pgmj.2005.036673

Department of Health. National Service Framework for Diabetes. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/198836/National_Service_Framework_for_Diabetes.pdf (accessed 7 Jan 2016).

Hunn A. Diabetes Year of Care Evaluation Report. Tribal Consulting, 2011.

Hull S, Chowdhury TA, Mathur R, Robson J. Improving outcomes for patients with type 2 diabetes using general practice networks: a quality improvement project in east London. BMJ Qual Saf 2014;23:171-6. http://dx.doi.org/10.1136/bmjqs-2013-002008

Gelding SV, Vijayaraghavan S, Davison C, Chowdhury TA. Community diabetes: an East London perspective. J R Soc Med 2005;98:96-100. https://doi.org/10.1258/jrsm.98.3.96

Vijayaraghavan S, O'Shea T, Campbell-Richards D, et al. DAWN: Diabetes Appointments via Webcam in Newham. Br J Diabetes Vasc Dis 2015; 15:123-6. http://dx.doi.org/10.15277/bjdvd.2015.026




DOI: http://dx.doi.org/10.15277/bjd.2016.108

Refbacks

  • There are currently no refbacks.


The Journal of the Association of British Clinical Diabetologists