Healthcare professionals in primary and secondary care, people living with diabetes
A need was identified as a result of the challenge of moving the care of people with diabetes from a secondary care setting to a primary care setting and the increasing requirements for care within the community. In addition, there was recognition of the vital role of self care by those with diabetes and those who care for them.
How this service improves
Patients have access to the same information as the healthcare professionals – nothing is hidden.
- There is consistency of information across the community.
- The focus is on ‘help me manage’ – whether this is the person with diabetes, their partner, the GP or the diabetes specialist team.
- To introduce the process of care planning in an innovative way, which carries on the initial self-management work delivered by the DESMOND newly diagnosed programme (for those with Type 2 diabetes).
- It is the main source of information about local services (including referral pathways to specialist services; local self-help groups etc).
Initially the idea was discussed at Diabetes UK meetings and then once a pilot website was ready, people with diabetes, practice nurses and GPs were given access to the website to provide vital feedback. The following comments are examples of feedback received which helped to further develop the site:
‘It is great to have a link between primary & secondary care & patients’ ‘Congratulations on a very detailed and useful website’
‘it might be useful to have more links to explain the acronyms or medical terms’
‘I felt that the information given was good but I found very little for anyone like myself who has been insulin dependant for a long time’
‘What an amazing amount of information!’
‘It is a very easy site to negotiate and find information’
The website was launched at the annual ‘patient conference’
The website is now managed and updated by a project co-ordinator based in a local GP practice. Anyone can access the website so its use is transferable.
One practice is now developing and implementing the care planning process to develop the website as an active component in care. In addition, the care Planning concept is supported by a ‘My Care Plan for Diabetes’ booklet (paper form and e-copy) which has been derived from the DESMOND approach already in place. The booklet mirrors the information on the website and is the hand held record that facilitates the care planning process in the community with self-management at the heart of the approach.
The website contains details and explanations of the process and informs and educates the service user, for example with sections on ‘What do my results mean?
The lead GP Dr James Hogan, produced a report of the findings of the project and this was presented to the Practice based commissioning PCT sub-committee.
The process of developing and setting up the website was developed from a project that included feedback from people with diabetes; self-assessment of evidenced care delivered by practices; learning sets with practice nurses; study sessions with primary care and specialist colleagues.
The website and its components is its own evidence. This is the only website of its form that involved the collaboration of 2 primary care trusts and an acute hospital trust as well as people with diabetes.
Since the launch at the local Diabetes UK Patient Conference in October 2009, the website has had 132 hits.
Healthcare professionals have contacted the project co-ordinator when using the site to suggest links, educational information and forms that need to be introduced to the site which indicates its use as a working tool in the community. The site links in to secondary care information thus sharing information more efficiently across primary and secondary care in the local area.
The service we have provided has demonstrated that large organisations can work together on a large project, complete it and agree!
This successful outcome was achieved through putting the person with diabetes at the focus of any discussion, underpinned by our guiding principle of ‘Help me manage’. The concerns we had of care planning becoming another paper exercise were diminished through the provision of the service which has put the people with diabetes in the driving seat. The service is being used and valued.
The website address is: www.portsmouthdiabetes.co.uk