It’s been nearly 5 years since Canterbury District Health Board looked at its community diabetes services and found they were unsustainable.
New ways of working were required if the DHB was to meet the needs of a rising number of people with Type 2 diabetes.
Now the DHB can point to changes such as these:
- the introduction of retinal screening in the community and an increased number of patients with diabetes accessing the screening programme
- a new Canterbury-wide podiatry service for high-needs patients
- more people with type 2 diabetes starting insulin with support in the community
- another diabetes nurse specialist being funded to work in paediatrics
- clinicians across primary and secondary care having a shared health pathway for diabetes
- the number of checks for diabetes being much higher than before.
Kit Hoeben was the Integrated Diabetes Service Manager at the time of the review and says the system had a high dependence on specialist hospital services.
General practices were also providing diabetes care, but not in a consistent way.
And the Get Checked programme that was supposed to identify any issues for people with diabetes or pre-diabetes was not working well in the region.
‘As a DHB, we wanted people with diabetes to be able to take good care of their health; stay well in their homes and communities; and receive the right care at the right time,’ he said.
The solution was to improve the connection between primary (or community) and secondary (or hospital) care.
This has safely released a substantial amount of the diabetes work that was being done in a specialist setting to general practice. The people who have become more involved in the community-based work include GPs, practice nurses, pharmacists, community nurses, community dietitians and GP liaisons.
In 2011, the Integrated Diabetes Service was formally established – part of the model across the DHB to have primary and secondary care working better together.
The cornerstones of the new way of working are a community-based diabetes nurse specialist and dietitian service; funding through the Diabetes Care Improvement Package (DCIP); community-based retinal screening; podiatry services for high-risk patients in the community; additional specialist paediatric services and more diabetes education for nurses and GPs.
Kit says, ‘the development of the community-based roles has been the key to the success of the Integrated Diabetes Service. We have had wonderfully positive feedback from consumers and it has generally been very well received by primary care.’
While the DHB is still gathering data to determine exactly how successful the changes have been, there have been some marked improvements.
‘The changes haven’t been easy for everyone and we’ve still got some work to do but overall we think we are now providing a much better service for Canterbury people with diabetes,’ Kit says.
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