Article
Improved clinical practice but continuing service deficiencies
following a regional audit of childhood diabetes mellitus
A J Drakea, J H Baumerb
a Taunton and Somerset
Hospital, Musgrove Park, Taunton, Somerset, UK, b Derriford Hospital, Plymouth PL6 8DH, UK
Correspondence to: Dr A J Drake, The Royal Hospital for Sick Children, St Michael's Hill, Bristol, UK
Accepted 14 December 1999
AIM
To assess the changes in
services for children with diabetes in the south west of England
between two regionwide audits performed in 1994 and 1998.
METHODSQuestionnaires were sent to
consultant paediatricians, specialist diabetes nurses, dietitians, and
Local Diabetes Service Advisory Groups. Information was gathered on
consultant and nursing caseload, clinic structure, dietetic and
psychological services, glycated haemoglobin use, and screening services.
RESULTSIn 1994 there were 21 consultant paediatricians caring for children with diabetes, only seven
of whom fulfilled the British Paediatric Association definition of a
specialist. By 1998 there were 14, 12 of whom fulfilled this
definition. In 1994 a significant number of children were being seen in
general paediatric clinics; by 1998 all centres stated that children
were being seen in designated diabetes clinics. Between the two audits,
despite a decrease in the average caseload of specialist diabetes
nurses, nursing services in many centres remained deficient, as did
dietetic and psychology services. Glycated haemoglobin use increased
from 16 of 21 consultants to all consultants. In 1998 there was still
patchy paediatric representation on Local Diabetes Service Advisory Groups.
CONCLUSIONSThe 1994 audit was
followed by a change in clinical practice, in contrast to continuing
deficiencies in resources, despite the availability of national
recommendations and the widespread distribution of the audit report to
those in a position of influence.
Keywords: diabetes mellitus; audit; quality of care
© 2000 by Archives of Disease in Childhood
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