in the Netherlands Care-standards
Structure of Workshop Short introduction: in the Netherlands 10min Discussion of 4 questions 60min How can self management be a part of diabetes disease management? How can prevention be a part of diabetes disease management? What are the main obstacles in building diabetes care groups? Which diabetes core-indicators are important for measuring patients health? Evaluation of answers 20min 2
Euro Consumer Diabetes Index 2008 1. Denmark (837 points out of 1000) 2. UK (836 points). 3. France (814) 4. The Netherlands (813) 5. Belgium (803) 6. Norway (781 points), 7. Italy (752) 8. Germany (751), 9. Ireland (733) 10. Switzerland (722) 3
Prevalence diabetes (male) 4
Prevalence diabetes (female) 5
Incidence diabetes (male) 6
Incidence diabetes (female) 7
Prevalence diabetes (1990-2025) 8
Cumulative Incidence diabetes (2010-2025) 9
Care standard Demand-based From a social point of view Care-components instead of care suppliers Prevention as an integral part of care Patient empowerment Outcomes of care in terms of health outcomes and social participation. Not a detailed blueprint 10
Self management The individual ability to deal properly with symptoms, therapy, physical and social consequences of chronic disease and associated changes in lifestyle. Self-management is effective when people are able to monitor their own health and cognitive, behavioural and emotional reactions and see how this will contribute to a satisfactory quality of life 11
NPCF 12
Care standard diabetes type 2* a comprehensive annual audit; three times a year, quarterly monitoring; an annual foot examination; an annual eye examination; dietary advice (frequency depending on how long the patient is aware of diabetes); laboratory (HbA1c, LDL-cholesterol, renal function determination, micro-albuminuria); stop-smoking advice or guidance. *The standard of care has recently expanded with two addenda: Type 1 Diabetes - Adult and Diabetes type 1 - children and adolescents. 13
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Organization of diabetes care A network of diabetes care groups is needed; The health insurers can promote the formation of diabetes care groups; With the purchase of the Network Diagnosis and Treatment Combinations (NDTC) Intergrated funding diabetes should be used for diabetes standard care; Reporting with clear parameters and indicators; Good ICT facilities are required; The empowerment of diabetic; Recast the role and composition of the diabetes group; Management Support in the formation of diabetes care groups; Support and supervision of the implementation by ZonMw; Knowledge of diabetes in the RIVM 15
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Core Indicators Integrated care diabetes in hospitals RIVM indicators Risk factors for the development of diabetes Epidemiology of (first stages of) diabetes Risk factors for the development of macro vascular complications Epidemiology of macro vascular complications of diabetes 17
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Functional funding Conditions: Presence of a care standard legitimate and accepted by care suppliers and patients. Reduce barriers for new care groups, instead of general practitioners. Increasing transparency for healthcare providers, health insurers and patients. Improve the position of the patient Health related prevention Ehealth ICT 20
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Prevention as part of the Health insurance act 1. (advice and guidance) to reduce the energy intake by an individual diet which leads to weight reduction; 2. (advice and guidance) to increase physical activity 3. to support behavioural interventions. self-monitoring of eating and physical activity; self-control; cognitive restructuring: adjustment unrealistic inadequate goals and beliefs about weight loss, body image and eating; problem-solving: to deal with difficult situations around eating and weight loss; social support: the immediate environment can help to support behavioural change. 22
National program diabetes Implementation of the NDF Care Standard ( 10 mln.) Education and lifestyle intervention Position of the client and patient Organization, quality and knowledge Legislation and finance EMD (ediabetes core set) and ICT services 23