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

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Thank You