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2008/5/15HA Convention 2008 1
Diabetes Mellitus Complication Screening
- Primary Health Care Nursing Perspectives
Ms. Carol A.L. Wong (RN, MPHC)
Kowloon Central ClusterGeneral Outpatient Clinic
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UKPDS
• Upon diagnosis of type 2 DM33% HT22% retinopathy of certain degree20% microalbuminuria
• Suboptimal DM controldeterioration in severity of complicationsincrease morbidity & mortality
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Macro-vascular Complications
• Stroke attack
• Coronary heart disease
• Peripheral vascular disease
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Micro-vascular Complications
• Diabetic Eye diseasesleading cause of visual impairmentglaucoma; cataractretinopathy & maculopathy
• Diabetic Neuropathy & DM footnon-traumatic amputation of lower limb
• Diabetic Nephropathyleading cause of end-stage renal failure
• Diabetic Erectile Dysfunction
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High medical cost for
Major DM Complications
• Stroke bed • Leg amputation • Renal dialysis • PTCA • Laser therapy for DM retinopathy
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Quality care for DM
• Prevent occurrence of DM complications
• Delay inevitable occurrence of the complications
• Decrease damage from existing complications
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Local Clinical Situation
• DM High prevalence rate • Asymptomatic in suboptimal control• Non-invasive screening tool available• Effective intervention available• Potential gain in quality of life• Save medical resources in long run
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Objectives
• Early detection of DM complications• Evaluation of level of DM control• Promote patient self management
Increase the awareness of DM complicationEmpowerment for self management
• Reduce DM related Morbidity / Mortality• Save the Society Cost in Long-run
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DMCS forDM Patients
attending KCC GOPCs
LKK YMT CK LM HH
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• Target: DM Patients• Protocol: HA DMCS Protocol• Annual target:7,800 cases • Fee of charge: as SOPC • Exclusion criteria:
Patients with limited lifespan (e.g. terminal cancer with diffuse metastasis)
Patients with poor cognitive / communication function (e.g. severe dementia)
• Waiting time: 1 – 2 week
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Role of Team Member
• Registered Nurse (Project Manager)Preparation, Arrangement & SupervisionFoot assessmentDigital retinal photo capturingCase assessment, education & counsellingRecruit patient to DM Support GroupLiaise with FM SpecialistCall back & follow upStaff training, statistic & research
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Role of Team Member
• Technical Service AssistantSpecimen collection (blood & urine)Simple Parameter MeasurementBP, Pulse, BMI, WHR, VA
+/- data entry
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Role of Team Member
• Family Medicine SpecialistLaboratory data analysisRetinal photo interpretationDMCS report synthesisProblem case referral & follow upProfessional advice & support in staff training
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RetinalPhoto
Capturing
Workflow & Logistic
Report synthesisFoot Assessment
ParameterMeasurement
Specimen CollectionRegistration
Booking
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Implementation PhasePhase I
Dec 05 – Aug 06(Pilot)
Phase IISep 06 – Sep 07
15 ~ 21 case /sessionone session per wk
•Increase Output in limited manpowerExtended to 5 GOPCs
4 ~ 6 case /sessionone session per wk
•Personnel training•Logistic design & arrangementLKK case only
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Implementation Phase
Phase IIISince Oct 07
(Full Implementation)
30 case /session5 sessions per wk
Full implementation of the project• Additional manpower• Support from Administration / Specialist• Target for whole coverage all DM in KCC
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Service Output
DMCS Attendance
15557
1812 1584
2384
0500
10001500200025003000
2005 2006 2007 2008 (Jan-Apr)
Total
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Service Output
DMCS Attendance by Clinic2005-2007
867481 470 420
146
2384
0500
10001500200025003000
LKK HH CK YMT LM Total
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Case Summary
71%
68%
10%
68%
51%
84%
23%
41%
15%
2%
0% 20% 40% 60% 80% 100%
Maculopathy
DMR
Cataract
Microalbumin
FBS > 6
HbA1c ≧7
Cholesteral > 4.5
VPT ≧ 25
Hypertention ≧ 130/85
BMI > 23
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Potential Benefit
• Patient Enhance self awarenessEmpowerment in self ManagementEarly detection & interventionImprove the quality of life Improved patient satisfaction
• NurseProfessional development & autonomyJob satisfaction
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Potential Benefit
• Primary Health Care Team workEnhance Intrasectoral Collaboration
• Contribution to the CommunityChronic disease management model Reduce the medical expenditure
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Essence of Success
• Establishing a New Service Model Entertain high volume of patient One Stop Complication ScreeningComprehensive programQuality service in primary sectorConsistent staff training standard
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Conclusion
• Successful in detecting complication
• Provide timely intervention
• Increased patient awareness & empowermentfor self care
• Enhanced nurse role in DM management
relieving doctor’s heavy workload
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AcknowledgementDr. David Chao, CCOS(FM & PHC)/KEC & KCC Dr. S C Tiu, CON (MED)/QEHDr. Victor Choi, SMO YMT JCCDr. Ching Kam Wing, FM Specialist / MO i/c LKKCDr. Law Tung Chi, FM Specialist / MO HHCDr. Ng Ying Wai, MO(MED)/QEHMs. Winnie Cheng, NS(MED)/QEHMs. Kathy Cheung, APN (W & UMgt) LKKC & HHCMs. Shirley Hung, APN (W & UMgt) CKHC & LKMDMs. Chan Lai Hung, APN (W & UMgt) YMT JCC
The Retinal Camera was sponsored by S K YEE Medical Foundation 2005