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Major changes in diabetes care proposed
[Posted: Tue 17/06/2008 by Niall Hunter, Editor www.irishhealth.com]
A major change in the way type 2 diabetes is treated in Ireland in order to cope with the explosion in the numbers of people with the condition has been recommended in new guidelines for health professionals.
However, an overall HSE strategy outlining how the diabetes epidemic can be dealt with has yet to be published despite being completed seven months ago.
It is estimated that the number of people with type 2 (non-insulin dependent) diabetes in this country will increase from the current 130,000 to up to 180,000 by 2015, thereby putting enormous pressure on hospitals to cope with the diabetes epidemic.
The diabetes epidemic has been fuelled by an increasingly obese and ageing population.
The new guidelines for health professionals published yesterday propose that diabetes care be delivered in future through an integrated system where treatment is shared between primary care, (including the GP, practice nurse and other community health professionals) and hospital care.
Under this system of shared care, which is currently only available in some areas of the country, GPs and hospital specialists assume joint responsibility for the care of diabetes patients.
The HSE has admitted that the new system will have funding implications. However, a HSE expert advisory group overall strategy for future diabetes care in Ireland has still not been published, despite being completed last October.
Launching the new guidelines , Health Minister Mary Harney said that as the new guidelines were rolled out, spending needed to be shifted from the hospital system to the new alternative care model proposed.
The Minister said the sustainability of current health spending was being debated around the world, and said the fact that people were living longer was now placing a huge burden on health systems. She said the prevention and management of chronic illness was therefore very important.
Under the integrated care system, diabetes patients would attend their GP for diabetes care every three months and this care would be backed up by dietetic, chiropody and ophthalmology services in the community.
Patients would only have to attend their local hospital once a year for a check-up under the integrated scheme.
The main author, midlands GP Dr Velma Harkins, said many of the structures were already in place in general practice to provide such schemes. She is already involved in an integrated scheme in the midlands and said such schemes could be easily expanded nationally.
The Minister told the launch that the management of chronic illnesses, including diabetes, would have to be a strong feature of a new GP contract which is due to be negotiated.
James Conway of the HSE's Palliative Care and Chronic Illness section, told irishhealth.com that the as
yet unpublished report of the HSE expert group on diabetes had been presented to the HSE management team and endorsed by it in April of this year.
He said various stakeholders had been consulted in terms of what was planned in the expert group report.
Mr Conway said many aspects of the strategy have resource consequences and a number of priority areas had been identified, including education and empowerment, diabetic eye screening, podiatry, paediatric and adolescent diabetes.
He said, however, not everything would require new or additional funding and there could be some reorganisation and reorientation of services.
Mr Conway said the HSE would be meeting shortly with the service deliverers in hospitals and primary and community care to see how the plan can be implemented.
He said developing integrated care as proposed in the new guidelines was the way forward.
Meanwhile, the Department of Health and the HSE will face criticism from representatives of diabetes professionals and patients at an Oireachtas Health Committee meeting later today for the failure to improve diabetes services in Ireland.
Diabetes specialists have for some time pointed to the lack of a national screening programme in Ireland for diabetic eye disease. If this is not detected at an early stage through screening patients with diabetes it causes blindness.
The HSE, at the launch of the new diabetes guidelines yesterday, said it would fund an additional eight posts this year to allow an eye screening scheme currently available in the north-west to expand to more counties.
However, as yet there are no plans for a national eye screening programme.
The guidelines stress the need to detect early the complications of diabetes such as eye and kidney disease, foot ulcers and heart disease.
The guidelines were drawn up by the Irish College of General Practitioners, the Irish Endocrine Society, the HSE and the Department of Health.
|Anonymous Posted: 20/06/2008 12:11|
|It seems we are bolting the door when the horse has left. Not only do we need a major change in the way type 2 diabetes is treated - we need majot changes in order to prevent the epidemic developing in the first place. Diabetes is not an inevitable any more than blindness is.|
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