综合糖尿病护理:英国临床糖尿病学家协会(ABCD)全国调查报告

IF 0.4 Q4 ENDOCRINOLOGY & METABOLISM British Journal of Diabetes Pub Date : 2021-12-17 DOI:10.15277/bjd.2021.325
D. Nagi, S. Rowles, Andrew Macklin, U. Dashora, Heather D Oliver, D. Patel
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引用次数: 1

摘要

在2019冠状病毒病大流行期间,英国临床糖尿病学家协会(ABCD)开展了一项关于综合糖尿病服务的全国调查,并就目前在英国提供综合糖尿病服务的整合状况提供了一些非常有用的见解。该调查于2020年下半年进行,主要探讨了三个方面:(1)初级和二级(专科)糖尿病服务的临床整合现状;(2)糖尿病IT系统与医院电子病历(electronic patient records, EPR)、医院与基层医疗的IT整合状况;(三)了解成员对“一站式服务”收集糖尿病年度回顾数据的意见,以及实现这一目标的潜在障碍。提交的结果是调查的摘要,而完整的未经编辑的调查报告,特别是关于定性方面的报告,可供ABCD成员使用。该调查邮寄给了518名个人,其中431名(83.2%)是顾问,53名(10.2%)是专业注册商。在收到的83份答复中,98%来自顾问医生,这些答复代表了73家医院糖尿病服务。这项调查的结果显示,初级保健和糖尿病专家团队之间的临床服务的全面整合并不常见,尽管有不同形式的临床整合的好例子。在许多领域,初级保健和糖尿病专科服务继续各自为营,尽管人们普遍认识到综合服务是可取的,而且可能提高护理质量。临床领导、资源和委托服务者的支持被认为是帮助改善综合护理系统发展的重要因素。在拥有专用糖尿病IT系统的医院中,从这些糖尿病系统到EPR的信息流并不普遍,这引起了人们的担忧,即在提供护理时,有关个人糖尿病的重要信息可能无法提供给其他医院的临床专科,从而构成重大的临床风险。在英格兰,初级和专科糖尿病团队之间的IT集成仅在某些地区可用,并且主要基于SystmOne的使用。调查还确定了关于目前质量结果框架(QOF)安排的多种意见,在QOF中,全科医生被激励收集数据以进行常规糖尿病护理的年度审查。许多人认为,年度审查过程应由负责向个人提供糖尿病护理的临床团队执行,而其他人则认为应继续保持现状,由初级保健全科医生负责。一站式的糖尿病眼部筛查服务和其他年度测量服务被认为是一种改进,但也发现了一些物流障碍。我们认识到任何表达参与者意见的调查的局限性。然而,我们认为目前的调查代表了英国糖尿病单位的重要比例,并提供了对糖尿病综合服务现状的见解。对于糖尿病社区来说,这是一个重要的学习,这些信息可以用来改善和激励英国糖尿病综合护理的提供。
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Integrated diabetes care: The Association of British Clinical Diabetologists (ABCD) national survey report
Executive Summary A national survey on integrated diabetes services was carried out by the Association of British Clinical Diabetologists (ABCD) during the COVID-19 pandemic and has provided some very useful insights into the current state of integration to deliver a joined-up diabetes service in the UK. This survey was carried out during the second half of 2020 and explored three main areas: (1) current state of clinical integration between primary and secondary (specialist) diabetes services; (2) the state of IT integration among the diabetes IT systems and hospital-based electronic patient records (EPR) and between hospital and primary care; (3) to ascertain the membership of their views on a ‘one-stop service’ for collecting annual review data for diabetes and the potential barriers to achieve this. The results presented are a summary of the survey, while the full unedited survey report, especially on the qualitative aspects, is available to ABCD members. The survey was mailed to 518 individuals, of which 431 (83.2%) were consultants and 53 (10.2%) were specialist registrars. Of the 83 replies received, 98% were from consultants and the responses represented a total of 73 hospital diabetes services. The findings of this survey revealed that full integration of clinical services among primary care and specialist diabetes teams is uncommon, although there are good examples of clinical integration in different formats. In a number of areas, primary care and specialist diabetes services continue to work in silos despite a universal recognition that integrated services are desirable and are likely to improve quality of care. Clinical leadership, resources and buy-in from those who commission services were deemed important factors to help improve the development of integrated care systems. In hospitals with dedicated diabetes IT systems the information flow from these diabetes systems to the EPR was not universal, raising concerns that vital information about an individual’s diabetes may not be available to other hospital clinical specialities at the time of delivery of care, posing a significant clinical risk. IT integration among primary and specialist diabetes teams in England was only available in certain areas and was mostly based around the use of SystmOne. The survey also identified a diversity of opinions regarding the current arrangements of the Quality Outcome Framework (QOF), where GPs are incentivised to collect data for annual review of routine diabetes care. Many were of the opinion that annual review processes should be performed by clinical teams who are tasked to deliver diabetes care to the individual, while others felt that the status quo should continue with primary care GPs being responsible. A one-stop service for eye screening for diabetes and other annual measurements nearer to people’s homes was identified as an improvement, but several logistic barriers were identified. We recognise the limitations of any survey which expresses opinions of participants. However, we believe the present survey represents a significant proportion of diabetes units in the UK and provides insights into the current state of integrated services in diabetes. There are significant learnings for diabetes communities, and the information can be used to improve and galvanise delivery of integrated diabetes care in the UK.
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来源期刊
British Journal of Diabetes
British Journal of Diabetes ENDOCRINOLOGY & METABOLISM-
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16.70%
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