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Ben RHM II - LZG.NRW

Ben RHM II - LZG.NRW

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ 5.3.4 Czech Republic (Moravia-Silesia) 51 Diabetes screening is performed in the Czech Republic according to the “Health Order“. (Health regulation, which implements the guidelines of the Czech Diabetes Society for the screening of diabetes mellitus). General practicioners have the major role in diabetes screening. They are responsible for inviting people aged more than 45 years old for fasting glycaemia sampling every two years. For the same sampling people at risk (with obesity, occurrence of diabetes in family history, occurrence of gestational DM, hypertensive persons, persons suffering from dyslipoproteinemia etc.) are also invited but in higher frequency (once a year) and independent of their age. The coverage of this screening is from public health insurance. General practitioners are instructed how to proceed in diagnostic algorithm to confirm or exclude diabetes and how to cope with borderline disorders of glucose homeostasis. These instructions are provided in regular educational activities provided in co-operation between the “Union of General Practicioners“ and the Regional Diabetes Centre. Unfortunately in the Moravia-Silesia region as in the Czech Republic, there are in general no regular inspection activities of the Regional Health Authority to survey this aspect of diabetes care. Neither the Czech Diabetes Society nor other professional bodies are involved in surveillance activities. Among the GPs there is an interindividual variability in call and recall systems but there is also an effort from the joint initiative between Health Insurance Companies and Regional Health Authority to fund only properly made screening examinations. The Health Insurance Companies record levels of attendance and non-attendance. Special interest in this field demands screening activities for socially deprived people, disabled people or ethnic minority groups. Dissemination of results and further treatment Diabetes screening is carried out by blood sampling in the fasting state. The examined person is informed about the result within a few days afterwards. In the case of elevation of blood sugar, the examined person is asked to undergo consecutive sampling or performance of oral glucose tolerance test, when needed. Persons diagnosed with diabetes first of all need education and nutritional advice. GPs can usually provide this information in very limited range in our region and that is why they often use the service of special diabetes outpatient offices. In these offices, diabetes nurses 51 Author: Dr Arnost Martinek, CSc, University Hospital, Ostrava. - 194 -

Benchmarking Regional Health Management II (Ben RHM II) ___________________________________________________________________________________________________________________________________________________________________ provide information so that people with diabetes develop the knowledge to self-manage their diabetes. GP´s or diabetes specialists take care of people with type 2 diabetes treated with diet or oral hypoglycaemic agents. In the Moravia-Silesia region as in the Czech Republic in gen- eral, diabetes specialists look after people with type 1 diabetes or type 2 diabetes treated with insulin. Information and education Citizens of our region were informed about diabetes mainly via booklets and posters produced by the National Institute of Public Health in the past. These information resources were distributed to health care facilities all over the region. Mass media play a great role in information campaigns nowadays, especially the Czech television which devotes several hours of broadcasting weekly to public health service and rises the interest of citizens in diabetes and related disorders. Patient organisations are active in this area too. Above all the “„Union of people with diabetes in the Czech Republic“ and the “Association of parents and friends of diabetic children“ organise educational courses, programmes of meetings of young people with diabetes and another activities aiming at motivation of people with diabetes. These organisations also issue specialised periodicals and arrange public collection for diabetes care and other activities for example: public measurement of glycaemia free of charge. There is a tight co-operation between the Czech Diabetes Society and patient organisations. They together propose to the Ministry of Health changes in health care policy aiming at the improvement of diabetes care. Patient organisations also try to influence policy making processes in the Parliament of the Czech Republic. The Ministry of Health grants the activity of patient organisations as part of the health promotion process. National Diabetes Programme Diabetes mellitus in the Czech Republic is a disease with a prevalence of more than 6%. Diabetes has a great impact not only on the level of health, but is also a huge socio-economic burden. The aim of NDP is the creation of conditions in the area of prevention and therapy, which will lead to the gradual decrease of chronic complications of diabetes. Implementation of the NDP supposes interest and co-operation of all governmental and non-governmental bodies, economic support and realization of guidelines developed by the Czech Diabetes Society in practice. According to this programme, basic diabetes care is organised as mentioned above. Highly specialised care is provided for patients with diabetes in Regional Diabetes Centres. - 195 -

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