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. 1998 Jul 11;317(7151):148. doi: 10.1136/bmj.317.7151.148b

Improving management of diabetes in residential and nursing homes

“Home clinic” facilitates communication with carers

Debbie Hicks 1, Steve Atkin 1, Ewan Masson 1, David Hepburn 1, Chris Walton 1
PMCID: PMC1113511  PMID: 9657809

Editor—Tattersall and Page highlighted the problem of providing diabetes care for patients in residential and nursing homes.1 In Hull we have attempted to tackle the growing problem of unstructured diabetes care in these establishments with the development of our “home clinic service.” 2 This service started in 1991 to provide structured diabetes care in the community by secondary care staff.

We had identified a small but increasing number of patients who attended the hospital based clinic but gained little from the consultation. A high proportion of this group lived in nursing or residential homes. They commonly required hospital transport, which prolonged the hospital visit, and usually had a relative or a professional carer providing day to day diabetes care and support. However, the carers rarely accompanied the patient on the hospital visit. Accurate information was often unavailable to assist the consultation, and the only reliable method of relaying changes made during the consultation back to the carer was by letter.

Referrals to our home clinic service are currently made only by consultant diabetologists, although some general practitioners have recently shown interest in purchasing this service for housebound patients with diabetes. The protocol encompasses all annual review procedures, which are carried out by a diabetes specialist nurse who visits the patients’ residence. Screening includes a foot examination, for which training was provided by the diabetes centre podiatrist. The nurse also arranges eye screening through a domiciliary visit by an optometrist or attendance at the ophthalmology department. Control of glycaemia is assessed and problems are discussed with the carer. The home visit improves communication and means that any changes to treatment can be made immediately and treatment goals can be discussed.

References

  • 1.Tattersall R, Page S. Managing diabetes in residential and nursing homes. BMJ. 1998;316:89. doi: 10.1136/bmj.316.7125.89. . (10 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Taylor CA, Hicks D, Norman A, Smith AC, Walton C. Home clinic service. Diabetic Med. 1994;2(suppl 2):S7. [Google Scholar]
BMJ. 1998 Jul 11;317(7151):148.

British Diabetic Association publishes guidance

Michael Hall 1

Editor—Tattersall and Page rightly draw attention to the lack of organised care for elderly people with diabetes living in residential and nursing homes.1-1 Given the large numbers of elderly people with diabetes, the increased risk of their admission to hospital, and the need for more visits by general practitioners1-2 the argument for improving the quality of care is irrefutable.

Simple measures such as ensuring that there is a link person in each home, educational input from a diabetes specialist nurse, and help for general practitioners to provide regular systematic care following locally agreed guidelines could have great effects. The British Diabetic Association has recently published a new edition of Recommendations for the Management of Diabetes in Primary Care,1-3 which would be helpful to those in primary care developing their own protocols. We also publish Diabetes Care Today—a Guide for Residential and Nursing Home Managers and Staff.1-4 The association is preparing a guidance document specifically aimed at the needs of people with diabetes in institutional care, and this should be available later this year.

References

  • 1-1.Tattersall R, Page S. Managing diabetes in residential and nursing homes. BMJ. 1998;316:89. doi: 10.1136/bmj.316.7125.89. . (10 January.) [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-2.Benbow SJ, Walsh A, Gill GV. Diabetes in the institutionalised elderly: a forgotten population? BMJ. 1997;315:1868–1870. doi: 10.1136/bmj.314.7098.1868. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 1-3.British Diabetic Association. Recommendations for the management of diabetes in primary care. London: BDA; 1997. [Google Scholar]
  • 1-4.British Diabetic Association. Diabetes care today—a guide for residential and nursing home managers and staff. London: BDA; 1994. [Google Scholar]

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