Introduction: NICE recommends specific annual health checks for children and young people (CYP) with diabetes aged 12 years and over to check for health of feet, kidneys, thyroid and eyes in addition to BP, BMI and HbA1c. Historically, we included annual review care processes into regular diabetes multi-disciplinary clinics. In 2017, our service was identified as negative outlier in the National Paediatric Diabetes Audit for completion of health care processes. In particular, completion rates for blood tests, urine analysis and foot examination were unsatisfactory. As part of a wider quality improvement project, dedicated Annual Review Clinics (ARC) were developed and started in September 2018. ARC consist of three separate 30 min appointments with nurse, dietitian and doctor; the clinic is run in the morning and located in close proximity to phlebotomy services. Specific ARC templates for each profession were designed.
Method: Retrospective audit comparing completion rate of specific care processes (blood test, urine analysis, foot exam) before and after introduction of a dedicated ARC. A total of 55 CYP aged ³12 years attended the newly designed ARC between September 2018 and March 2019. Data on investigations (blood tests, urine analysis) and foot examination were collected from the laboratory database and diabetes management system respectively. Completion rates of specific annual review care processes for those CYP were compared with their individual completion rates for the same care processes during the previous year.
Outcomes: The rate of completion increased for all of the specific care processes. Almost 93% (51/55 CYP) had at least one of the assessments completed in the Annual Review Clinic compared to 70% (29/55) for the same group for the previous year. The same CYP had much higher completion rates for the specific care processes compared to the previous year (foot exam 87.2% vs 63.6%; blood test 87.2% vs 65.5%; urine analysis 81.8% vs 49%). More CYP had all seven recommended care processes completed.
Conclusion: A dedicated Annual Review Clinic is effective in ensuring CYP with diabetes receive recommended health care processes. Ongoing review of clinic processes is required to ensure completion rates improve further to maximise health.
27 - 29 Nov 2019
British Society for Paediatric Endocrinology and Diabetes