Quality outcomes for a diabetes service

Current NHS policy is to move services for chronic disease out of the hospital sector into the community, with services managed by a variety of health care professionals. There are often no clinical outcome measures specified for such clinics, and we therefore describe results for one such service run by a consultant, a dietitian and a specialist nurse.

The clinic is hosted by an urban GP practice, and reviews patients with a view to problem solving, management planning and discharge.

During a representative period, between 1 April 2007 and 31 March 2008, 144 patients were seen in 285 visits with a new:follow‐up ratio of 1:0.98. The non‐attendance rate runs between 15 and 20%. In a 21‐month period, 213 patients were referred with conditions requiring improvement in diabetes control. Baseline HbA1c was 10.0(0.14)% (mean [SEM]), and had fallen to 8.8(0.12)% at the time of discharge (p<0.01). Fifty‐three of these subjects were judged to need insulin. In this group, the HbA1c fell from 10.64(0.3)% to 8.6(0.2)% (p<0.01). In the remaining 160 individuals who needed reinforcement of advice, tablet or insulin titration, the HbA1c fell from 9.8(0.15)% to 8.8(0.14)% (p<0.01).

The data here provide quality markers for a community diabetes clinic. Further figures from other services are required to provide commissioners with realistic quality markers against which services could be compared. Copyright © 2009 John Wiley & Sons.