Friday, 14 October 2011

Checklists - the way forward for diabetes care?

A new checklist for people with diabetes to monitor whether they are receiving the essential care they require has been launched by Diabetes UK as part of its ‘Diabetes Watch’ campaign.  Diabetes Watch aims to hold health services to account for the care they provide for people with diabetes.

It’s an admirable aim and one that Diabetes UK will pursue with its usual vigour and clarity. The idea of ensuring that people receive standard aspects of care that has been shown to make a difference, and raising their awareness of what they should receive would seem to be a logical step. It also made us think about how having a checklist sits alongside the personalised approach to health that is, happily, currently being recommended.

A closer look at the 15 measure checklist shows that it focuses most on the medical aspects of care, for example having measurements such as blood glucose, blood pressure and blood fat levels, weight, feet and eye checks. It also defines where specialist care is required, such as for children and young people and those who are pregnant.

These aspects are really important in diabetes care, and emphasis on them has driven up standards in recent years, so it is absolutely right for them to be included in the list. However, they all also imply a certain passivity – that someone else will weigh, measure, take your blood and deliver your baby, for example. There is rather less on the list about active involvement by the person in their own care, an approach known to to help people live successfully day to day with their condition. ‘Receiving care planning to give you an equal say about your individual needs’, ‘attending education courses to learn how to manage your diabetes yourself’, and ‘getting psychological and emotional support’ are all included in the list, and are important. But there is a massive amount of other evidence about the effects of people being more involved in consultations, and in decision making about their own needs. This leads to a greater satisfaction with consultations as well as effective self-management of the condition. Like some medical evidence about what works, this knowledge is not always translated into practice in consultations and so perhaps should also be included in a checklist for monitoring a service for diabetes?

So, we’ve come up with our own ‘supporting self care’ checklist – some ideas for aspects that could be used to measure the ‘way’ care is provided, to complement the ‘what’ of the items in the Diabetes UK checklist. Here are the ideas we had:

SD ‘Supporting Self Care’ Checklist

  • You are given the chance to receive your test and investigation results in advance of the consultation where you discuss them
  • You are invited in advance to think about what you most want to discuss in your consultation
  • In the consultation, you are asked what you want to achieve in relation to your health
  • You get the chance to ask questions at the beginning of, and throughout, your consultation
  • You are able to change your appointment easily if you are unable to attend
  • You are asked if you would like a reminder to attend your appointment and the most convenient way to receive this
  • Your thoughts and ideas about your treatment options are listened to and discussed
  • You are asked about how you feel - emotionally as well as physically
  • You are offered relevant information about what is available to help you, in a format that is useful to you
  • At the end of a consultation you are clear about what you are going to do and what your health professional is going to do and when you will next be in touch with each other
  • You are able to get in touch with your health professional easily and quickly between appointments

Let us know what you think of checklists in general – and what would you add to either of these checklists, from your experience?

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