What a year 2015 has been! And hopefully it's the start of the type 1 diabetes community coming together to meet face to face every year.
We are aiming to pull off Thriveabetes 2016 in October again and will pin a definite date down early in the new year (fingers crossed).
Thanks to every single one of you for joining the party, making your voices heard and most of all for supporting Thriveabetes 2015.
Happy Christmas to you all from,
Grainne, Rebecca & Christine.
I've been sifting through the document to find out exactly what's in it. Ultimately, it’s a suggestion for a plan. But! There is a lot in it!
As a place to start improving services for families with type 1 diabetes it’s a good one. It actually calls for the service to be completely redesigned! Thumbs up from me:-D
Professor Hillary Hoey, chairperson of Diabetes Ireland stated that “Overall, it is a good day for the paediatric Type 1 diabetes community. This model of care provides a strong platform on which to build a high quality service. We now need to see implementation of the care model by the HSE as soon as possible”.
Firstly, this document is limited to children and young people under the age of 18 with type 1 diabetes. And not 16 years as it was under as is the current unofficial national policy. (thumbs up again!)
Here are the Key Recommendations for Implementation of this Model of Care:
- Services should be organised within Integrated Practice Units (IPUs) comprising of a Centre of Reference (CofR) and a number of additional units.
- It is recommended that a IPU/centre of reference will have between 150 and 300 patients.
- IPUs should be equipped with the core staffing requirements. Staffing recommendations for the IPU can be determined on a pro rata basis from the following:
- A reduction in general paediatric workload may be required for the lead paediatric endocrinologist in each IPU.
- Adequate staffing should facilitate the availability of 24-hour telephone support within each IPU.
- Each IPU will need to develop governance arrangements which cross current geographic boundaries.
- In order to facilitate these activities (Page 30), commissioners would need to commission jointly an appropriate IPU infrastructure, which might include:
- The Additional units will support the delivery of services locally, acting under the ‘umbrella’ of the IPU.
- It is recommended that a local units have less than 150 patients attending and will be linked to a larger centre of reference for provision of more complex care.
- Ongoing training and structured education of paediatric diabetes teams is required annually.
- National, quality assured, educational programmes for children with type 1 diabetes and their families and carers should be developed.
- Ongoing patient and parental engagement is required, for example with links with Diabetes Ireland.
- Appropriate national information and communication technology infrastructure and support is needed.
- Accurate baseline data is required in the form of an active electronic database for longitudinal data, this will allow ongoing audit and appropriate service development. A financial incentive has been suggested for each IPU, CofR and Unit to achieve their standards.
Education programmes should be available to the child, their family and ideally staff members from the child’s school. Examples of educational programmes would include carbohydrate counting and structured pump schools, e.g. FABB, CHOICE. (page 24)
Once basic skills are mastered, a more intensive educational programme can be initiated based on the families stage of engagement
Refresher Education periodically
The structured education programmes to be used by multidisciplinary teams to optimise diabetes education, carbohydrate counting and insulin pump initiation.
All children and young people is <7.5% (59 mmol/l) (ADA, 2014). (page 26) Define the goals to be achieved for HbA1c in different age groups.
Recommended follow up clinic visits are three to four monthly in a dedicated paediatric diabetes outpatient clinic. All children with type 1 diabetes should have an annual review when a child is diagnosed with T1DM for greater than five years or the child is older than 12 years of age (ISPAD & ADA). An annual review should consist of eyes, feet and cardiovascular review along with routine annual bloods for thyroid, coeliac and fasting lipids. (Page 26)
From initial diagnosis of diabetes, children and their families should be encouraged to link with patient groups such as Diabetes Ireland. These groups are helpful for children and families in the initial stages of diagnosis when they need peer support.
The involvement of a psychologist with any diabetes service is universally recommended, and screening for psychological morbidity at diagnosis has also been recently suggested. Therefore, dedicated access to a psychologist and a social worker for each IPU is recommended. (Page 28)
This document calls for the a complete redesign of the service and for all the stakeholders to start discussions and consultations with each other. A lot of what the model of care is calling for is already in place in some paediatric diabetes clinics so I would like to think it is NOT going to take the 5 - 10 years that is expected to implement.
“Diabetes Ireland is calling on the various HSE regional managers to prioritise implementation of the IPU’s and provide the necessary resources (financial and human) as a matter of urgency. We will of course be engaging with the HSE to deliver this, at a local and national level” added Professor Hoey
Diabetes Ireland have an action plan for national level activity but, and this is just my opinion, we have a part to play in this too. What if, every family, at their next clinic appointment, asks every member of their child’s team what their clinic is doing to get “Model of Care” ready, it will ensure that they know we have expectations and that our patience has limits.
It may even speed up the implementation if we are applying pressure from the ground?
I am a member of the Clare Type 1 Diabetes Support group and our guest speaker last month is a podiatrist from the local health centre (Thank you, Doireann). I know that most people with diabetes already know the basics of taking care of your feet, especially if you have been around diabetes for a couple of decades. But I decided to post about our meeting because the pathway to podiatry care for people with diabetes has changed a little in recent years and that is worth sharing this information (IMO).
But I have included an article which, coincidently, was published online the same week as our meeting, and contains some of the basics to lead up to the local information, if you would like a reminder as to why it's soooo important to look after feet.
Your very first foot screening with your podiatrist will assess you and place your feet in one of three categories; Low, Moderate or High risk.
If you are low risk, you may be referred back to your GP’s surgery for your annual foot exam. If this is the case then it will be your responsibility to schedule this. If you are referred to your GP, it’s really important that you keep a record of when your last foot check was and when to schedule your next one.
If you are Moderate or high risk of diabetes foot disease then you will probably continue to be seen in the Diabetic Foot Clinic, where they will send out your appointment to you in the post.
However, there are instances where the clinics fall behind in their appointments and it would be wise if you kept a record of when your last foot exam was and when your next one should be.
You can find more information from the HSE's Model of Care for the Diabetic Foot document, which was revised in October 2014.
At our meeting some people pointed out that their feet are checked at their regular diabetes clinic appointment.
While this is a good "spot check", if your foot check does not include a test using a tuning fork and a Monofilament tool, it is NOT a full foot exam.
Everybody with diabetes in Ireland should have a foot check by a podiatrist, children included, every year.
Here's to Happy Feet!
Regards,
Grainne
