Authors (including presenting author) :
Hung SY, Chou PK, Chan YL, Lam SKS, Lo YM, Leung KF, Leung WCW, Leung PSC, Li HLF, Kwan WYW, Cheung PH, Chow WPA, Cheung YHK, Wong MSM, Wong MYM
Affiliation :
Department of Family Medicine and Primary Healthcare, Hong Kong East Cluster
Introduction :
Care of people with diabetes mellitus (DM) can be challenging. In the General Outpatient Clinic (GOPCs) of the Hong Kong East Cluster, the number of diabetic patients increased from 14445 to 28292 in the past decade. People with diabetes are two to three times more likely to develop cardiovascular diseases than the non-diabetics. Optimizing ‘ABC’ i.e. hemoglobin A1c, blood pressure and cholesterol levels can prevent cardiovascular complications.
Objectives :
1.To review the strategies used for optimizing ‘ABC’ of DM patients in GOPCs
2.To review the ‘ABC’ of DM patients of the past decade
Methodology :
Risk Assessment and Management Program (RAMP) was launched in 2009. DM patients underwent cardiovascular risk assessment and management of risks and complications identified. A multidisciplinary team stationed to provide one-stop service. There were regular interactive training sessions for staff and audits to ensure quality standard.
After the first round of RAMP service in three of our clinics, the program was rolled out to other urban clinics. Outreaching RAMP service at outlying island clinics was started in 2013.
Innovative education methods have been put in place since 2012, e.g. Diabetes Conversation Map. Staff also received training on motivation interviewing technique.
A Quality Assurance Subcommittee was set up in 2017 to further monitor and review service key performance indices, identify areas of improvement, consolidate and co-ordinate the implementation of service quality improvement strategies, and standardize practices. Improvement works included:
1.Redesigning and standardizing DM patient journey in clinics;
2.Reviewing and standardizing DM education tools;
3.Creating and displaying innovative DM education booths in clinics, e.g. glycemic index booth with food models, toy capsule vending machine.
Result & Outcome :
From 2008 to 2018, the changes in proportion of DM patients attaining optimal ‘ABC’ were as follows:
1.HbA1c < 7%: increased from 40% to 58.1%;
2.Blood pressure < 130/80mmHg: increased from 30.4% to 48.1%;
3.Low-density lipoprotein < 2.6mmol/L: increased from 55.4% to 75.1%.
Effective and innovative approaches could improve the ‘ABC’ of diabetic patients and hence decrease cardiovascular complications.
