Authors (including presenting author) :
Wu CY(1)(2), Yip HM(1)(2), Chan CY(1)(2), Tsang KW(1), Wan KY(1)(2), Yiu YK(1), Luk W(1), Leung MYR(1), Ho SF(1)
Affiliation :
(1) Department of Family Medicine and Primary Health Care (FM&PHC), Kowloon West Cluster, (2) Lady Trench General Outpatient Clinic
Introduction :
Type II Diabetes Mellitus (DM) is one of the most important chronic diseases handled by family physicians in General Out-patient Clinics (GOPCs). Increasing demand on basal insulin therapy has been observed in primary care setting. Achieving good diabetic control requires interdisciplinary approach and patients’ collaboration. To tackle this, a specialized clinic targeting patients using insulin was set up in 10/2019 at Lady Trench GOPC.
Objectives :
• To improve DM control in patients on basal insulin therapy
• To reinforce and enhance interdisciplinary care in target patients
• To increase both patients’ and medical team’s satisfaction
Methodology :
The Insulin Clinic rolled out on 9/10/2019 with “One-stop Interdisciplinary Approach” as the backbone. Insulin Clinic runs weekly on every Wednesday AM and PM. Patients on insulin were recruited from regular GOPC sessions. At Insulin Clinic, they received combined care from physicians, DM specialized nurses and dietitian, addressing different areas of diabetic management.
Quotas were specifically designed to allow patients to attend physician, nurse, and dietitian consultations on the same day. The arrangement aims to improve patients’ compliance to follow-up including nurse and dietetic sessions, especially for the working class. Clinical issues picked up at consultation can be addressed promptly with instant interdisciplinary communication, e.g. hypoglycaemic attacks managed with drug titration by physician, reviewing drug compliance and injection technique by nurse, as well as dietary modification by dietitian. More frequent follow-ups were feasible for intensive intervention.
Result & Outcome :
Since the commencement of Insulin Clinic, 192 patients were recruited and followed up. Encouraging results were shown 1 year after commencement. First and foremost, the overall diabetic control in the recruited patients improved. Overall, 69.6% of patients had improved HbA1c with a mean HbA1c reduction of 1.2%. 37% of them achieved their latest HbA1c < 7.5%, compared with 27% at their first attendance. 59% of them achieved latest HbA1c< 8%, compared with 42% at entry. One of the cornerstones leading to improvement was drug regimen refinement. 53% of recruited patients successfully stopped using sulphonylurea, while another 32% of had down-titration. The “One-stop Interdisciplinary Approach” also reinforced patients’ attendance of nurse and dietetic sessions. Dedicated nurse sessions (573) and dietitian sessions (268) were arranged to facilitate interdisciplinary collaboration and intervention at patients’ attendances for physician’s follow-up. Attendance rate of these sessions was improved. The results are delightful to both patients and medical team. In future, further allied health input from Physiotherapist is anticipated. With this interdisciplinary approach, patients on insulin therapy in primary care setting can benefit from enhanced quality of care.
