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Staged Diabetes Management
A New Approach to Diabetes Care Launched
Diabetes is one of the fastest-growing diseases all over the world, including
South Asia. Today, the world is facing a diabetes epidemic
with an estimated 150 million people with Diabetes Type 2
and this number is expected to double, reaching an alarming
figure of almost 300 million by 2025. Pakistan is not far
behind, with a currently estimated 6.5 million people with
diabetes. If no intervention strategies are adopted, the WHO
projected estimates for Pakistan in 2025, would rise to 14.5
million people with diabetes.
Ms. Rozmin Jamal, Honorary Consultant to the SDM project is currently
working as Adjunct Assistant Professor, Health Sciences at
the George Washington University, Washington, DC, USA and
Vice President NUTRI-FIT Canada. She was instrumental in bringing
the SDM project to the Aga Khan Health institutions and also
contributed in promoting collaboration amongst AKU, Aga Khan
Health Service, Pakistan (AKHS, P), BD (Becton Dickinson and
Company) and IDC (International Diabetes Centre, Minnesota).
To give due recognition, both to her professional expertise
and voluntary efforts, she was appointed as honorary lecturer
in the AKU Department of Community Health Sciences from April
1, 2000 for a period of three years.
AKHS, P has taken a lead to address this problem and a joint initiative
for establishing comprehensive diabetes services at AKU and
AKHS, P was taken in March 1999, with partnerships between
AKU, AKHS, P, Becton Dickinson and Nutri-Fit Canada. This
joint AKU/AKHS, P venture aims to provide quality diabetes
care and improve clinical outcomes at all levels of care in
both institutions, using the ‘Staged Diabetes Management’
model. The staged care approach combines patient education
with an enhancing clinical quality of care using an algorithm
approach.
To start with, the programme was launched at 12 primary health care outlets
of AKHS, P and AKUH. The different components of the proposed
comprehensive diabetes care programme are to be implemented
over a five-year period. Each phase has specific goals and
activities outlined:
- raining programmes for health professionals, to enhance competency in
managing and delivering diabetes care, using the Staged
Diabetes Management Model;
- Developing and implementing patient
diabetes education centres with an aim to educate, promote
and facilitate self-management of diabetes;
- Establishing Patient Diabetes Supply
and Training Centres to improve patient access to reliable
diabetes supplies with correct training and instructions
for use;
- Integrating the care and treatment
of diabetes-associated morbidities;
- Initiating, developing and implementing Diabetes research and related infrastructure
to support research activity aimed at improving the understanding
of diabetes specific to the local population.
The programme aims to assist in the delivery of quality care by inspiring
maximum involvement and support of the entire team of health
professionals involved in diabetes care. This spirit and commitment
was evident in all the activities conducted during Year 1.
These activities included:
- A baseline assessment of the currently available facilities at the Aga
Khan Network institutions to identify the gaps and requirements
for implementing a diabetes care programme;
- A joint AKU-AKHS, P outcomes workshop attended by 50 medical and multi-disciplinary
health professionals in which diabetes care, systems, process
and financial outcome parameters were defined;
- A two-day joint consensus development workshop attended by 60 selected
medical and allied health representatives;
- A two-day, skill development and training workshop, attended by 135 core
medical and allied health professionals;
- A full-time Diabetes and Endocrinology Clinic in the D1 ward at AKUH,
which started in
March 2000. In addition, the Division of Family Medicine,
Community Health Sciences, commenced diabetes treatment
service at the Community Health Centre on a part-time basis
(two days/week) in September 2000.
The programme is in its second year and two key initiatives are currently
in progress both at AKU and AKHS, P:
- Development and standardization of patient diabetes history/assessment
and patient care/progress form;
- Development of an integrated, computerized, diabetes patient database
to provide easy access of selected clinical information
and facilitate the monitoring of multiple outcomes.
Once fully implemented, this programme will help to provide efficient
and effective diabetes care at all levels.
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