A decade of change in diabetes services in a deprived multiethnic inner city area: diabetes in Tower Hamlets

Abstract

Introduction: Diabetes care in deprived multiethnic inner city areas can be challenging. Old models of care need to evolve to take into account demographic change, increasing prevalence of the condition and scarcity of resources.

Strategies for change: A managed clinical network was tasked with implementing the standards of the Diabetes National Service Framework. Working with patients and other stakeholders, the group developed a model of care based around enhanced diabetes care in primary care, with specialist care reserved for more complex patients. Specialist support for primary care clinicians was provided by community-based multidisciplinary team meetings held within each primary care locality (network). Structured programmes for education of patients and health professionals were provided by the specialist team. Subsequently, use of National Diabetes Inpatient Audit (NaDIA) data enabled us to attract additional resources to improve diabetes inpatient care.

Outcomes: Between 2008/9 and 2012/3, completed care plans rose from 10% to 88% and attendances for retinal screening rose from 72% to 82.8%. The proportion of patients achieving a combination of blood pressure ≤140/80 mmHg and cholesterol ≤4 mmol/L rose from 35.3% to 46.1%, and mean glycated haemoglobin dropped from 62 mmol/mol to 60 mmol/mol (7.80% to 7.66%). Referrals to specialist care fell from 25 per week to six per week. NaDIA data also showed significant improvements in inpatient diabetes outcomes.

Conclusions: Partnership between patients, specialists and primary care to improve diabetes care in multiethnic deprived inner city areas can achieve significant improvements in outcomes. Fundamental to the success of this approach is to hold regular clinical meetings between specialist and primary care clinicians and allow rapid access to support and advice. Patient and health professional education also enables care to be delivered effectively, locally to the patient. Future challenges include managing the ever-growing demands within a shrinking financial envelope and developing prevention measures to reduce the prevalence of diabetes in the area.