National Diabetes Programme
2013
Ronan Canavan
National Diabetes Programme
NAGP AGM 23rd Nov 2013
Clinical Care Programmes
• “Deliver better care through better use of
resources”.
• RCPI & HSE appointment
• Access
• Quality
• Cost
National Director
Clinical Care
Programmes
& Strategy
Group Managers
(Group Leads)
Retinopathy
NCSS/NCCP
Stakeholder Groups
&
DSIGs
Core Strategic
Team
Ronan Canavan
Marie Tighe
Orlaith O’Reilly
For IC
Deirdre Hall
(GP)
Research,
Policy Development
National Diabetes
Working Group
Gateway Group
(Steering Board))
Integrated Care
Overall Steering
Group
In Patient Diabetes
Management
& Diabetes Bundles
Diabetes in
Pregnancy
Subgroup
ICT Prototype
Team
National
Multidisciplinary
Footcare Package
Structured
Education
Paediatric Diabetes
Subgroup
Prevalence and Cost of
Diabetes
• 5.6% of the adult Irish population have diabetes
(190,000)
• Estimated that the number of patients with Type 2
diabetes will increase by 60% over next 10-15 years
• WHO states diabetes is the greatest health challenge
of the century
• 10% of the Irish Health Care budget spent on diabetes
– €1.35 billion annually
• 60% of complications (€816 million of this budget is
spent on complications)
Change in diabetes incidence 1991 - 2011
700
SIR per 100,000
600
500
400
whole pop
< 40
300
200
100
0
1991-96
1997-01
2002-06
5 year period
2007-11
Men
Women
Diabetes in Ireland,
South Dublin/Wicklow
Percentage of DM in whole population ?
In 2005 the estimated population prevalence of Type 1 and Type 2 diabetes in
adults was 5.4% in Northern Ireland and 4.7% in the Republic of Ireland.
In 2015 will be 6.3% (84,226 adults) in Northern Ireland and
5.6% (193,944 adults) in the Republic of Ireland.
2007
2010
2013
2015
Annual estimates
11664
13636
15608
16922
Wicklow Catchments
3616
4227
5307
5753
St Dublin Catchments
8048
9409
10301
11169
increase 45.1%
National Diabetes Programme
2013
1. National Retinopathy Screening Programme (Implementation
NCSS)
2. Foot care screening and treatment service to prevent diabetic foot
ulceration and lower limb amputation.
3. Integrated Care Programme for all patients with diabetes with
employment of 17 integrated nurse posts
4. ICT development programme & National Diabetes Register.
5. National Model of Care for children and young adults with Type 1
diabetes and the implementation of continuous subcutaneous insulin
infusion therapy for children with type 1 diabetes < 5 years
(Implementation National Paediatric Programme)
6. Other workstreams – pregnancy/structured education/diabetes
bundles
National Diabetic Retinopathy Screening
Programme
• Register compiled 145,000 patients
• Pilot commenced Q1 – 2013
• 7 treatment centres with MOU
• 1,500/wk invitations being issues in initial start areas Q3
• Expansion to 2,000 – 3,000/wk in Q4 (all of east cost &
areas outside Dublin)
• Target for 2013 – invitation to 30% of 145,000
• Screening & Treatment costs for remaining 70% in 2014
in NSP
National Diabetes Foot Care
Programme
• First part of diabetes programme to role out in 2011 but
pause in implementation
• Nov 2013 11.45 of 16 WTE in post
• Reduction of 2061 bed days in 2012 with only partial
implementation
• Practice nurse education on diabetic foot risk assessment
• Variation in diabetic foot MDT access nationally
• 8 WTE specialist podiatry posts in NSP 2014
Integrated Care Diabetes Package
• All patients with Type 1 diabetes, complex & genetic
will be managed in Secondary Care only (30,000
patients)
• Uncomplicated Type 2 Diabetes patients will be
managed in Primary Care only (100,000 patients)
• Complicated Type 2 Diabetes patients will be managed
by both Primary and Secondary Care (60,000 patients)
Integrated Care Diabetes Package
• 9/2/5/1 of 17 integrated nurse specialists in post
with other posts progressing to support
implementation of model of care in T2DM
• 10 shared/structured (not integrated care)
schemes nationally
• Evaluation of how posts are impacting on
patients identified in model of care?
Integrated diabetes nursing activity
•
Structured education
– Assessing delivery in terms of quality and access
– Addressing issues of access in terms of redirecting programmes if over delivered in
certain areas
– Directing or delivering where provision is absent
•
Practice involvement
–
–
–
–
–
•
Liaison with practice nurse key
Assessing diabetes register provision & supporting where not developed
Establishing if call and recall systems are effective within practices
Assessing numbers of DM in practice and in network population
Some direct patient involvement is allowed but should be very much directed
involvement Supporting injectable treatment initiation
Across practices and region
–
–
–
–
–
–
Educational support to practices, localities
Audit of diabetes practice within and across practices
Diabetes facilitator role not envisaged across the whole region
Secondary care patient profile, suitability for integrated care or intermediate care
Diabetes prevention programmes to be encouraged and supported
Good practice in use of resources for diabetes care to be audited e.g. use of and
following guidelines, glucose test strip usage, supporting chronic disease initiatives –
around diet, exercise, and weight.
Additional Diabetes Work Streams
• Pregnancy
– Updated national diabetes in pregnancy guidelines
– National screening guidelines for GDM
– LTI scheme & GDM
• ICT – to support communication
• Paediatric diabetes
• Research – HRB/RCQPS
2013 - 2014 challenges
• Ongoing funding of the retinopathy screening &
treatment programme to cover 100% of register
• Complete the employment of original 16 WTE &
additional 8 WTE diabetes specialist podiatry
posts
• Filling & evaluation of integrated care nursing
posts
• National diabetes audit & research
• Guidelines for T1DM & tertiary diabetes care