Healthcare professional requirements for the care of adult diabetes patients managed with insulin pumps in Australia

作者：Xu, S.; Alexander, K.; Bryant, W.; Cohen, N.; Craig, M. E.; Forbes, M.; Fulcher, G.; Greenaway, T.; Harrison, N.; Holmes-Walker, D. J.; Howard, G.; Jackson, J.; Jenkins, A.; Kamp, M.; Kaye, J.; Sinha, A.; Stranks, S.; O'Neal, D.^*; Colman, P.

来源：Internal Medicine Journal, 2015, 45(1): 86-93.

DOI：10.1111/imj.12619

• insulin
• insulin infusion system
• health resource
• health service need and demand
• type 1 diabetes mellitus

BackgroundHealthcare professional (HCP) time supporting insulin pump therapy (IPT) has not been documented, yet it is important in planning and allocating resources for effective care. @@@ AimThis study aims to determine HCP time spent in IPT patient care to inform resource planning for optimal IPT delivery. @@@ MethodsTwenty-four Australian adult IPT-experienced institutions (14 government funded, seven private, three both) collected data between April 2012 and January 2013 prospectively, including: patient demographics, HCP classification, purpose of HCP-patient interaction, interaction mode and HCP time with the patient. A subset of patients was tracked from pre-pump education until stable on IPT. @@@ ResultsData on 2577 HCP-adult patient interactions (62% face-to-face, 29% remote, 9% administrative) were collected over 12.2 6.4 weeks for 895 patients; age 35.4 +/- 14.2 years; 67% female; 99% type 1 diabetes, representing 25% of all IPT patients of the institutions. Time (hours) spent on IPT interactions per centre per week were: nurses 5.4 +/- 2.8, dietitians 0.4 +/- 0.2 and doctors 1.0 +/- 0.5. IPT starts accounted for 48% of IPT interaction time. The percentage of available diabetes clinic time spent on outpatient IPT interactions was 20.4%, 4.6% and 2.7% for nurses, dietitians and doctors respectively. Fifteen patients tracked from pre-pump to stabilisation over 11.8 +/- 4.5 weeks, required a median (range) of 9.2 (3.0-20.9), 2.4 (0.5-6.0) and 1.8 (0.5-5.4) hours per patient from nurses, dietitians and doctors respectively. @@@ ConclusionsIPT patient care represents a substantial investment in HCP time, particularly for nurses. Funding models for IPT care need urgent review to ensure this now mainstream therapy integrates well into healthcare resources.

• 出版日期2015-1