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Introduction .
Summary •
Pathways •
Team & contacts •
New patient •
Continuing care •
Guidelines •
Developments •
Audits / targets •
References •
Glossary •
Appendices •
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PATHWAY PRINCIPLES
- EDUCATION – Effective and regular education for patients, carers and professionals is the fundamental building block of appropriate care.
- DIABETES TEAM – Includes all those active in care of diabetes, professional, patients and carers. The Diabetes Team crosses organisational boundaries.
- RESPONSIBILTY – The responsibility for delivering the aims of this pathway is shared by all members of the Diabetes Team.
- PRIMARY CARE LED – The majority of patients will receive care from their primary health care team (PHCT). Guidelines indicate when it is appropriate to refer to the specialist team, and when appropriate care can be transferred back to the PHCT.
- APPROPRIATE CARE – All patients receive care from the diabetes team. Most will receive care from the primary health care team. The specialist team will deliver care, where this is appropriate.
- COMMUNICATION – When care is transferred between PHCT and Specialist Team, full information exchange is essential for the effective transfer of care.
- CALL-RECALL – Essential components of systematic care and must involve all ‘special’11 groups.
- AUDIT – of outcomes, used to shape further service development.
