T i m e Benchmarking Regional Health Management II (BenRHMII) ___________________________________________________________________________________________________________________________________________________________________ Illus. 32: Reference framework – diabetes (type II) – primary prevention, screening, secondary and tertiary prevention – Saxony-Anhalt (DE) Primary Prevention Screening Secondary Prevention Tertiary Prevention The Individual / Immediate Setting • Community oriented prevention / setting approaches • Social-medical counselling • Check-ups for people who see doctors for other reasons • General screening, preferably one-step screening should be offered to each pregnant woman. • Screening for overweight pregnant women • Promotion of self-testing • Offer of patient education/seminars about self-care and lifestyle • Involvement of patients and families in planning the delivery of care • Education of patients’ families about self-care and lifestyle • Patient training • Offer of seminars (smoking, alcohol, overweight) • Screening for complications • Management of long term & fatal complications • Annual foot exams among people with diabetes • Treatment of elevated blood pressure • Dilated/annual eye exam A c t i o n L e v e l The Population • Information about consequences of unhealthy lifestyles • Provision of evidence based information • Addiction prevention programmes • Health promotion campaigns • Lifestyle oriented prevention campaigns (e.g. campaigns on healthy food) • Motivating measures to increase participation in health check ups in target groups • People from 35 years on: regular health check-ups: urine, glucose, blood pressure, weight, blood lipids • Regular health check-ups for people with family history in diabetes • Screening in individuals with abdominal adiposity (men), hypertriglyceridaemia (women), hypertension, and parental diabetes history. • Broadly based screening programmes looking for metabolic and cardiovascular risk factors and for early disturbances of carbohydrate metabolism particularly in middleage groups • Information campaigns • Provision of education programmes for patients Mutual-help groups (should): • be supported (by physicians etc.) • participate in development and quality assurance of health/disease management programmes • Strategy for detection and management of long-term & fatal complications - 332 - The Social System, the Legislative, the State, Professions • Implementation of anti-obesity programmes • Implementation of education programmes • Creation of living conditions that promote healthy living (e.g sidewalks to motivate people in cities to walk, healthy food in schools etc.) • Establishment of seals of approval for trustworthy information • Impact on cultural lifestyle habits (taxations, prohibitions etc.) • Consumer protection laws (e.g. nutritional information) • Financing of preventive checkups • Evidence based strategy in place for prevention of diabetes type 2, including monitoring and evaluation components • Investment in professional development of workforce • Provision of education programmes for professionals • Improvement of competence of physicians, nurses, staff etc. to communicate with patients • Training of competence of communication of health professionals (doctors, nurses) • DMPs/Integrated Care • Assurance of insulin provision (different types, sufficient insulin) • Assurance of test strips provision • Raising awareness of health professionals • Incentives for health professionals to detect complications Overall Goals: Reduce diabetes-related deaths Strategic Points [Indicators] • Reduce cases of diabetes [Prevalence] • Prevent new cases of diabetes [Incidence] • Improve the education of the population about lifestyle dependent health risks • Promote healthier lifestyles • Raise uptake rate of medical, preventive check-ups • Identify more persons at higher risk • Identify more persons with diabetes • Raise uptake of examinations for early detection • Reduce mortality • Improvement of the education of professionals • Achieve pregnancy outcome in the diabetic women that approximates that of the nondiabetic woman • Identify more pregnant women with diabetes • Increase number of people with diabetes self-monitoring glucose • Improve number of educated patients [Participation rate in education programmes] • Involve more patients in decision-making process • Reduce hospitalisation among people with diabetes [Hospitalisation rate] • Improve responding of care to individual needs • Raise degree of health literacy and information about the disease/disease-management among people with diabetes • More involvement of mutualhelp groups • Assuring tertiary prevention • Reduce cases of complications: diabetic renal failure; foot ulcers; limp amputations; respiratory complications; blindness, cardiovascular diseases etc.
Benchmarking Regional Health Management II (BenRHMII) ___________________________________________________________________________________________________________________________________________________________________ 9.4.3 Preliminary conclusions In particular the data regarding the health performance indicators on diabetes (type II) at the regional level shows that in this respect much remains to be done to achieve comparable regional data in future. When considering the fact that according to WHO estimates a considerable increase in diabetics worldwide has to be expected, arrangements should be made for the foreseeable future so that in future this “dark spot” will not exclude any analyses at the regional level (WHO 2006). When collecting data on diabetes, care should be taken to distinguish between diabetes (type I) and diabetes (type II). This distinction will help to adequately consider both patient groups and to collect valid and reliable data. According to the CDC Foundation (2006), the proportion of the population hit by diabetes (type I) presently amounts to about five or ten percent of all diagnosed cases and type 2 diabetes affects 90 to 95 percent of people with diabetes. It remains to be stated that due to the analysis performed only first steps towards comprehensive benchmarking in the health management of diabetes (type II) could be carried out. Among others, education campaigns to prevent diabetes and diabetes risk factors, integrated care programmes and a diabetes surveillance system, were identified as common interventions in the analysed regions. However, they could not be verified as good practice since the significant shortage of information. Therefore, many improvements are still required when it comes to collecting diabetes-related data. 9.5 Conclusions The developed method to identify good practice is a recommendable tool for the benchmark- ing of health management approaches. The method can and should be further applied in other regional projects. With it is possible to show where health management is successful and gives other regions hints with what regions to compare themselves for improving their health managements. With the help of the Reference Frameworks, it becomes clear what interven- tions and policies contribute to good practice. Yet, the results of the identification of good practice show some deficits in the health management of the three tracers in the participating regions: the data held and provided in the region is insufficient for good health management – at least when we consider the Health Per- formance Indicators the Steering Group had identified and defined for good health manage- - 333 -