ABCD position statement on risk stratification of adult patients with diabetes during COVID-19 pandemic

At the time of submission of this manuscript, the COVID-19 pandemic had cost nearly 60,000 lives in the UK. This number currently stands at over 120,000 deaths. A high proportion (one third) of these lived with diabetes. The huge acute and emergency medicine effort to support people with COVID-19 has had a major knock-on impact on the delivery of routine clinical care, especially for long-term conditions like diabetes.Challenges to the delivery of diabetes services during this period include a reduction in medical and nursing staff, limitations placed by social distancing on physical clinical space, and balancing virtual vs face-to-face care. There is a need to re-group and re-organise how we deliver routine out-patient adult diabetes services during the ongoing COVID-19 pandemic. We offer some suggestions for how patients can be stratified into red (urgent), amber (priority) and green (routine) follow up with suggestions of how often people should be seen. We also offer recommendation on how we can identify those at highest risk and try and minimise the long- term impact of COVID on diabetes careDuring the COVID pandemic we have seen things happen in days that previously took years. The restart of diabetes services has triggered a more widespread use of virtual consultations and data management systems, but also offers an opportunity for more joined-up and cohesive working between primary and specialist care. While we do our best to keep our patients and colleagues safe, this pandemic is already proving to be a catalyst for change, accelerating the appropriate use of technology in diabetes care and implementing innovative solutions. To achieve this aspiration, further work – currently led by the Association of British Clinical Diabetologists in collaboration with Diabetes UK and the Primary Care Diabetes Society – to make recommendations on future proofing diabetes care in UK is in progress.

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Can social media reduce discrimination and ignorance towards patients with long term conditions? A chronic kidney disease example in the UK and more widely

Patient Experience Journal ◽

10.35680/2372-0247.1049 ◽

2016 ◽

Vol 3 (1) ◽

pp. 35-41

Author(s):

Shahid N Muhammad ◽

Amy J Zahra ◽

Howard J Leicester ◽

Heather Davis ◽

Stephen Davis

Keyword(s):

Chronic Kidney Disease ◽

Social Media ◽

Kidney Disease ◽

Long Term Conditions ◽

The Uk

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The context of healthcare

Oxford Handbook of Primary Care and Community Nursing ◽

10.1093/med/9780198831822.003.0001 ◽

2020 ◽

pp. 1-34

Keyword(s):

Public Health ◽

Primary Care ◽

Northern Ireland ◽

Healthcare Services ◽

Health Profile ◽

Long Term Conditions ◽

Key Concepts ◽

The Uk

This chapter begins by covering the UK health profile, then defines the key concepts in primary care and public health, and outlines the generic long-term conditions model. It provides a brief overview of the National Health Service, including differences in England, Northern Ireland, Scotland, and Wales. It covers current NHS entitlements for people from overseas, commissioning of services, and public health in a broader context. It also describes health needs assessment, and provides an overview of the services in primary care, the role of general practice, and other primary healthcare services. Further services, including those to prevent unplanned hospital admission, aid hospital discharge, those that support children and families, housing, social support, and care homes are all covered.

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Lucky or privileged? Working with memory and reflexivity

History of Education Review ◽

10.1108/her-10-2017-0018 ◽

2018 ◽

Vol 47 (2) ◽

pp. 208-216 ◽

Cited By ~ 1

Author(s):

Christine Trimingham Jack

Keyword(s):

Teacher Educator ◽

Boarding School ◽

School Experience ◽

Unique Contribution ◽

Content Type ◽

Educational History ◽

Secondary Sources ◽

Long Term Impact ◽

The Uk

Purpose Through a case study of the decision making that led to the writer becoming a teacher educator, the purpose of this paper is to contribute to historiography by exploring the complex process of surfacing and interpreting memory. Design/methodology/approach The methodology draws on the concepts of autobiographical memory and reflexivity, together with documentary and archival sources including newspapers and secondary sources. Findings The outcome reveals that the process of memory is complex. It illustrates that allowing the participant a wide scope to work with pivotal memories, which may include those referring to material objects, may lead to unexpected and compelling explanations that have the power to change thinking in regards to related aspects of educational history. In this particular case, the findings reveal the long-term impact of boarding school experience. Originality/value The paper expands the way in which educational historians may think about undertaking interviews by illustrating the need for investment of time and close attention to all memories, some of which may at first seem to be irrelevant. Additionally, while a significant amount of research had been published on the long-term impact of boarding school experience on students in the UK, a little critical historical work has been undertaken in regards to the Australian experience – this paper offers a unique contribution to the undertaking of that project.

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Preventing falls and falls-injuries in hospitals and long-term care facilities

Reviews in Clinical Gerontology ◽

10.1017/s0959259808002451 ◽

2007 ◽

Vol 17 (2) ◽

pp. 75-91 ◽

Cited By ~ 18

Author(s):

David Oliver

Keyword(s):

Older People ◽

Long Term Care ◽

Falls Prevention ◽

Care Homes ◽

Term Care ◽

Long Term Conditions ◽

Global Challenge ◽

The Uk ◽

Developed Nations

Falls are predominantly a problem of older people. In the UK, people over 65 currently account for around 60% of admissions and 70% of bed days in hospitals. There are approximately half a million older people in long-term care settings – many with frailty and multiple long-term conditions. The proportion of the population over 65 years is predicted to rise 25% by 2025, and that over 80 by 50%, with a similar increase in those with dependence for two or more activities of daily living. Despite policies to drive care to the community, it is likely that the proportion of older people in hospitals and care homes will therefore increase. Accidental falls are the commonest reported patient/resident safety incidents. Similar demographic trends can be seen in all developed nations, so that the growing problem of fall prevention in institutions is a global challenge. There has been far more focus in falls-prevention research on older people in ‘community’ settings, but falls are a pressing issue for hospitals and care homes, and a threat to the safety of patients and residents, even if a relatively small percentage of the population is in those settings at any one time.

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Patient satisfaction with a nurse-led, telephone-based disease management service in Birmingham

Journal of Telemedicine and Telecare ◽

10.1258/135763307781645194 ◽

2007 ◽

Vol 13 (1_suppl) ◽

pp. 3-4 ◽

Cited By ~ 5

Author(s):

Pejman Azarmina ◽

Jill Lewis

Keyword(s):

Disease Management ◽

Response Rate ◽

Management Service ◽

Educational Materials ◽

Long Term Conditions ◽

Qualitative Feedback ◽

Telephone Calls ◽

The Uk

In April 2006, a nurse-led telephone-based service was launched in Birmingham to improve the health outcomes of up to 2000 patients with high-risk, long-term conditions. Patients received regular telephone calls and educational materials selected according to their conditions. In August 2006, 506 questionnaires with 30 five-point Likert-type questions were sent to patients and 128 were returned within four weeks (25% response rate). The results showed that 96% of the respondents strongly agreed or agreed that they were satisfied with the quality of service being provided by the care managers. The educational material (care books) was found to be informative, easy to read and easy to understand. The qualitative feedback indicated that patients perceived the service to be useful, accessible and helped them to be more efficient in taking care of themselves. More than 40% of the patients agreed that the service reduced their need to go to hospital. Using a telephone-based disease management service seems to be an acceptable option for patients with long-term conditions in the UK.

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The combined care clinic: a strategy in improving quality and efficiency related to essential patient reviews in the UK

British Journal of General Practice ◽

10.3399/bjgp19x703565 ◽

2019 ◽

Vol 69 (suppl 1) ◽

pp. bjgp19X703565

Author(s):

Nishaan Khoosal ◽

David Swanson ◽

Girish Purohit ◽

Cath Morgan ◽

Amit Bharkhada

Keyword(s):

Patient Care ◽

Blood Pressure Measurement ◽

Healthcare Team ◽

Percentage Increase ◽

Long Term Conditions ◽

Care Clinic ◽

Practice Nurses ◽

Patients With Diabetes ◽

One Stop ◽

The Uk

BackgroundStandardised delivery of patient care remains an essential facet of the NHS. In 2004, the general practice contract for delivering specific primary medical services incorporated a financial payment: Quality Outcomes Framework (QOF). In majority of practices, these reviews are completed by the practice nursing healthcare team.AimTo understand if the combined care (CC) clinic improves the efficiency in delivering patient reviews.MethodThe CC clinic was designed in 2015 inviting patients with diabetes; who may also have other long-term conditions, to be addressed in a ‘one stop’ approach. It is implemented by healthcare assistants (HCAs) supported by apprentices, who perform standard checks such as blood pressures, urine dipstick checks, smoking data, and health promotion that are protocolled. Where there are abnormalities noted, the HCA is able to escalate to the practice nurses who are supported by a GP lead.ResultsQOF diabetes data were reviewed from 2015–2016 (636 patients on register) and 2016–2017 (649 patients on register). Results showed a marked percentage increase between years in the following indicators: DM003 (last blood pressure measurement ≤140/80 mmHg) 7.29%; DM006 (proteinuria/microalbuminuria) 6.20%; and DM009 (foot exam) 3.21%. All other diabetic indicators apart from two showed a percentage increase. The proportion of patients seen between April–October also increased in the subsequent year.ConclusionThe CC clinic provides a method of patient review in an efficient process, without the need for multiple visits, thereby increasing practice capacity to focus on other aspects of patient care and work streams.

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Impact of the UK COVID-19 pandemic on HbA1c testing and its implications for diabetes diagnosis and management

10.22541/au.160770263.30907582/v1 ◽

2020 ◽

Author(s):

David Holland ◽

Adrian Heald ◽

Mike Stedman ◽

Lewis Green ◽

Jonathan Scargill ◽

...

Keyword(s):

Diabetes Mellitus ◽

Diabetes Diagnosis ◽

Long Term Conditions ◽

Diagnosis And Management ◽

Increased Risk ◽

Poor Outcomes ◽

The Uk ◽

The Impact

Our findings illustrate the widespread collateral impact of implementing measures to mitigate the impact of COVID-19 in people with, or being investigated for diabetes mellitus (DM). Ironically, failure to focus of the wider implications for people with DM and other groups with long-term conditions, may place them at increased risk of poor outcomes from SARS-CoV-2 infection itself, irrespective of the implications for their longer-term health prospects.

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GP’s perspectives on laboratory test use for monitoring long-term conditions: an audit of current testing practice

BMC Family Practice ◽

10.1186/s12875-020-01331-6 ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Martha M. C. Elwenspoek ◽

Ed Mann ◽

Katharine Alsop ◽

Hannah Clark ◽

Rita Patel ◽

...

Keyword(s):

Online Survey ◽

Liver Function Tests ◽

Free Text ◽

Negative Consequences ◽

Patient Harm ◽

Long Term Conditions ◽

Current Testing ◽

The Uk ◽

Robust Evidence

Abstract Background We have shown previously that current recommendations in UK guidelines for monitoring long-term conditions are largely based on expert opinion. Due to a lack of robust evidence on optimal monitoring strategies and testing intervals, the guidelines are unclear and incomplete. This uncertainty may underly variation in testing that has been observed across the UK between GP practices and regions. Methods Our objective was to audit current testing practices of GPs in the UK; in particular, perspectives on laboratory tests for monitoring long-term conditions, the workload, and how confident GPs are in ordering and interpreting these tests. We designed an online survey consisting of multiple-choice and open-ended questions that was promoted on social media and in newsletters targeting GPs practicing in UK. The survey was live between October–November 2019. The results were analysed using a mixed-methods approach. Results The survey was completed by 550 GPs, of whom 69% had more than 10 years of experience. The majority spent more than 30 min per day on testing (78%), but only half of the respondents felt confident in dealing with abnormal results (53%). There was a high level of disagreement for whether liver function tests and full blood counts should be done ‘routinely’, ‘sometimes’, or ‘never’ in patients with a certain long-term condition. The free text comments revealed three common themes: (1) pressures that promote over-testing, i.e. guidelines or protocols, workload from secondary care, fear of missing something, patient expectations; (2) negative consequences of over-testing, i.e. increased workload and patient harm; and (3) uncertainties due to lack of evidence and unclear guidelines. Conclusion These results confirm the variation that has been observed in test ordering data. The results also show that most GPs spent a significant part of their day ordering and interpreting monitoring tests. The lack of confidence in knowing how to act on abnormal test results underlines the urgent need for robust evidence on optimal testing and the development of clear and unambiguous testing recommendations. Uncertainties surrounding optimal testing has resulted in an over-use of tests, which leads to a waste of resources, increased GP workload and potential patient harm.

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