Endocrine Abstracts

As medical science and technology have advanced health care delivery in diabetes has struggled to provide consistent high quality care. In the United Kingdom the National Service Framework (NSF) for Diabetes and guidelines from the National Institute for Clinical Excellence lay out the direction of care but do not performance manage care to achieve real improvements in health.

There remains a shortfall between knowledge acquisition and safe and appropriate translation into practice. Diabetes mellitus is a classic chronic disease that requires continuous monitoring/input, involves different specialities and a high level of patient/parent involvement. Although the complexity is acknowledged in practice there is little evidence that health care systems really understand these complexities and tend to go on providing the type of care that was delivered 10–20 years ago. Service provision is prone to widespread inconsistencies in care delivery and outcomes. The Health care offered for children and adolescents with diabetes has safety and quality problems because the system that is utilised is largely outmoded. If we wish to advance the course for Paediatric and adolescent diabetes then system redesign is essential.

This redesign will require practice of the principles of chronic care:

1. Use protocol or plan that says what has to be done, at what time intervals and by whom. Links multiple visits and contacts.

2. Redesign to incorporate regular patient contact, collect adequate data and look to how to provide education and training to manage their condition.

3. Focus on patient information and self management. Structured programmes.

4. Links with carers of chronic illness patient.

5. Registries for proactive management and outcome evaluation.

This presentation will evaluate how this might be achieved using examples from several of these areas.