Primary care, secondary care or both: is there a consensus on long term management of diabetes mellitus?

2009 ◽  
Vol 26 (6) ◽  
pp. 231-237 ◽  
Author(s):  
DE Flanagan ◽  
A Craig ◽  
PJ English
Keyword(s):  
Diabetes Mellitus ◽  
Primary Care ◽  
Secondary Care ◽  
Term Management

scholarly journals Implementation of a novel primary care pathway for patients with severe and enduring mental illness

2017 ◽  
Vol 41 (6) ◽  
pp. 314-319 ◽  
Author(s):  
Frank Röhricht ◽  
Gopal Krishan Waddon ◽  
Paul Binfield ◽  
Rhiannon England ◽  
Richard Fradgley ◽  
...  
Keyword(s):  
Primary Care ◽  
Mental Illness ◽  
Secondary Care ◽  
Care Pathway ◽  
Care Service ◽  
Significant Proportion ◽  
Cost Effective ◽  
Care Patient ◽  
Care Models

Aims and methodNew collaborative care models with an emphasis on primary care are required for long-term management of patients with severe and enduring mental illness (SMI). We conducted a descriptive evaluation of clinical outcomes of the first 3 years of a novel enhanced primary care (EPC) service. Data from 2818 patients and staff survey results were analysed.Results2310 patients were discharged to EPC (508 not assessed as clinically suitable or patients/general practitioners declined the transfer); mean length of stay with secondary care service of the cohort was 9.8 years (range 0–24). 717 patients (31%) have been discharged to primary care only out of the EPC services and 233 patients (10%) have been transferred back to secondary care. Patient and staff satisfaction with the new EPC model was high. No severe untoward incidents were recorded.Clinical implicationsThe data suggest that EPC can be safely provided for a significant proportion of patients with SMI, who traditionally received long-term secondary care support. The novel EPC model can be utilised as a template for the provision of cost-effective, recovery-oriented and non-stigmatising care in the community.

Diabetes

2016 ◽  
Keyword(s):  
Diabetes Mellitus ◽  
Insulin Resistance ◽  
Metabolic Syndrome ◽  
Diabetic Retinopathy ◽  
Diabetic Nephropathy ◽  
Diabetic Neuropathy ◽  
Endocrine System ◽  
Basic Training ◽  
Term Management

Chapter 8 covers the basic science and clinical topics relating to the endocrine system which trainees are required to learn as part of their basic training and demonstrate in the MRCP. It covers diabetes mellitus, diabetic emergencies, diabetes-long-term management, diabetic retinopathy, diabetic neuropathy, diabetic nephropathy, the diabetic foot, diabetic skin, the diabetic pregnancy, and metabolic syndrome and insulin resistance.

scholarly journals Diabetes mellitus. III: Complications and organising long-term management.

BMJ ◽  
1981 ◽  
Vol 283 (6294) ◽  
pp. 763-765
Author(s):  
J Jarrett ◽  
T Stewart ◽  
L Rogers
Keyword(s):  
Diabetes Mellitus ◽  
Term Management

scholarly journals Evaluating the effectiveness of a support programme for people with type 2 diabetes mellitus in primary care: an observational prospective study in Ecuador

BJGP Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. bjgpopen20X101025
Author(s):  
Francisco Barrera-Guarderas ◽  
Katherine De la Torre-Cisneros ◽  
Maria Barrionuevo-Tapia ◽  
Carmen Cabezas-Escobar
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Type 2 Diabetes Mellitus ◽  
Ocular Fundus ◽  
Network Support ◽  
Support Programme

BackgroundThe success of primary health care relies on the integration of empowered practitioners with cooperative patients regardless of socioeconomic status. Using resources efficiently would help to improve healthcare promotion and reduce complications of chronic non-communicable diseases (NCDs). The importance of network support programmes relies on the fact that they allow to accurately deliver medical care by shaping a sense of community and purpose among the patients.AimTo evaluate the effectiveness of a network support programme for patients with type 2 diabetes mellitus (T2DM).Design & settingA centre-based observational prospective study took place in a primary care setting in Ecuador.MethodThe impact of the diabetes care programme was assessed by comparing initial and final metabolic characteristics and outcomes of 593 patients with T2DM, followed-up from April 2007 to December 2017, using paired sample t-test. Electrocardiograms (ECGs), ankle-brachial indexes (ABIs), ocular fundus, and monofilament neuropathy tests were assessed with the McNemar test to evaluate complications at the beginning and end of the study.ResultsGlycated haemoglobin (HbA1c), lipid profile, and systolic blood pressure (SBP) showed statistically significant decreases between the initial measurement (IMs) and final measurements (FMs). In the FM, significantly lower HbA1c, diastolic blood pressure (DBP), and atherogenic index were found. Despite the length of time since diagnosis, during the follow-up time, long-term micro- and macro-vascular complications, such as ocular fundus, serum creatinine, and ABI, remained unchanged throughout the period of active participation in this healthcare programme.ConclusionThis study demonstrates the feasibility of reducing plasma glucose, plasma lipids, and long-term complications in patients with T2DM by implementing a network support programme, which involves the medical team and patients themselves in an environment with limited resources.

scholarly journals Long-term management after liver transplantation: Primary care physician versus hepatologist

2009 ◽  
Vol 15 (10) ◽  
pp. 1330-1335 ◽  
Author(s):  
J. Christie Heller ◽  
Allan V. Prochazka ◽  
Gregory T. Everson ◽  
Lisa M. Forman
Keyword(s):  
Primary Care ◽  
Liver Transplantation ◽  
Primary Care Physician ◽  
Care Physician ◽  
Term Management
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