Audit of diabetes care by caseload
a Department of Child Health, Derriford Hospital,
Plymouth PL6 8DH, b Institute of Child Health,
Bristol: Department of Medical Statistics, c Department of Child Health
Correspondence to: Dr Baumer.
Accepted 17 March 1997
OBJECTIVE
To investigate the relationship between
clinic provision, consultant and nursing caseload, and processes and
outcomes of diabetes care in children.
DESIGNRetrospective audit in the South Western
region of England of 801 children and young people with diabetes; 701 were seen in a designated clinic. Seven of 21 consultants fulfilled the
British Paediatric Association (BPA) criteria for a specialist in
childhood diabetes. Seventeen nurses provided specialist care.
MAIN OUTCOME MEASURESGlycated haemoglobin,
admissions to hospital clinic attendance rates, contacts with a
dietitian, measurements of height and weight, and screening rates for
hypertension, microalbuminuria, and retinopathy.
RESULTSChildren under the care of
`non-specialists' had higher admission rates to hospital with all
diabetes related problems and for hypoglycaemia and lower screening
rates for microalbuminuria than those under `specialists'. Children
under the care of the two tertiary hospital consultants had lowest
glycated haemoglobin results, spent least time in hospital at
diagnosis, were most likely to have their heights and weights plotted,
and to be screened for microalbuminuria and retinopathy, had higher
admission rates, lower clinic attendance rates, and fewer dietitian
consultations. Higher nursing caseloads were associated with longer
periods of admission at diagnosis, better clinic attendance rates,
reduced rates of admission after diagnosis, and less likelihood of
having blood pressure measured and being screened for microalbuminuria. Children attending general paediatric clinics were less likely to be
seen by a dietitian and to have their height and weight plotted.
CONCLUSIONSThe results are consistent with the
recommendation of a BPA working party in 1990 that children with
diabetes should be cared for by specialist paediatricians with a
caseload of more than 40 children, and that children should be seen in
a designated diabetic clinic.
© 1997 by Archives of Disease in Childhood
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