Summary
It is important that young people with diabetes make a safe transition from paediatric services to adult services. A specific dedicated team for the care of young people with diabetes (aged 15-23 years) was established in Poole in 2014 using best practice tariff (BPT) funding, to ensure good transition care. More recently the team has expanded to include care in Bournemouth. With 10 years of data, the team has demonstrated that care at this important time for young people with diabetes can be continuously improved through looking at data and co-design of services with patients.
Innovation/Novel approach to an existing problem
Prior to 2014, there had been a young person’s diabetes clinic in the Diabetes Centre at Poole Hospital to help young people transition from the paediatric diabetes service to the adult one. There were no staff dedicated to this, so when the adult diabetes service was under pressure, team members would be diverted elsewhere. In 2014, paediatric diabetes BPT funding was identified as applicable to patients aged 15-19 years, so a dedicated team for the Poole young people's diabetes service (YPDS) was created, with specific consultant time, a dedicated diabetes nurse specialist, dedicated diabetes specialist dietician and clinical psychologist time, plus an administrative assistant to collect data to inform service improvement and ensure that the service ran smoothly. The ethos of the new team was to put the patient at the centre of care, and to provide holistic care. In 2020, Poole and Bournemouth trusts merged to create University Hospitals Dorset NHS Foundation Trust (UHD), and a YPDS was formed for all UHD patients. YPDS innovations included: prospective data collection by the administration team; pre-clinic questionnaires for patients; psychology screening questionnaires for patients, with follow-up by the clinical psychology team as required; weekly MDT meetings; regular meetings with trust safeguarding team; YPDS diabetes nurse specialist attending paediatric clinic to meet patients joining; YPDS recruitment of a youth worker; telephone and video appointments (patient’s choice); nurse-led clinics; for those aged over 19 years use of SMS (text) messaging as a point of contact and appointment reminder; use of social media (Instagram) to engage with young people with diabetes; widespread use of insulin pumps and hybrid-closed loop (HCL) therapy; 24-hour paediatric team phone line for patients aged up to 19 years and their parents/family/carers.
Equality, Diversity and Variation
Treating all patients equally is an important part of the team’s philosophy. Discussion of each patient reviewed at the weekly MDT meeting ensures that the voice of every team member is heard, ensuring equity in provision of care. When funding for diabetes technologies became available, the socioeconomic status of all patients was assessed to ensure that treatment was offered according to need rather than patient request. This was important to ensure equity of access for those in lower socioeconomic classes. Access to services is flexible to the needs of the individual patient. There are options for patient communication, such as text, email, telephone and face-to-face or video consultations. The team works hard to eradicate any bias and make the service equitable for all. This was really highlighted during the pandemic.
Impact to Patient Care
All audits around inpatient admissions, HbA1c results and attendance rates have indicated a positive impact on a young person’s outcomes. Patients have continuity of staff who are separate to the general adult team. Feedback suggests that this is highly valued by this patient cohort and their parents/family/carers. Frequent discussions between all members of the MDT means the team is responsive to patients’ needs and issues are found and resolved quickly. Use of secure SMS (text) messaging means that young people feel comfortable about contacting the team and there are fewer missed appointments through SMS reminders. The 24-hour phone line ensures safer care.
Results
Despite an increase in patient numbers between 2014 and 2024, the dedicated YPDS has improved clinical outcomes. Patient numbers increased from 75 in 2014 to 132 in 2024, with no change in type of diabetes (97.0% type 1). There was no change in rate of clinic non-attendance (DNA) the average annual DNA rate being 17.6%. Average HbA1c fell between from 76 mmol/mol in 2014 (when the service was established) to 72 mmol/mol in 2024 (before the implementation of HCL systems). The number of patients with a diabetes-related hospital admission fell from 26 (35% of patients) in 2014 to 19 (13% of patients) in 2024. Patient feedback has been consistently positive, with the team responsive to patient suggestions and changing the service accordingly.
User Feedback
Over the last ten years, service user feedback has been sought in a variety of ways, including anonymous surveys online, by hand in clinics, social media polls, and asking face to face at events. The service has been developed to accommodate the needs of the whole cohort. Feedback is taken from parents/carers to understand how best to support them too. All users who joined the transition service from Paediatrics are asked: What did you like about your transition? What would you change? Any other comments, questions or concerns? This results in a robust tailored transition programme. Feedback on the team’s social media, newsletters, education offering, appointment frequency and methods has been invaluable in supporting the development of the service. When asked about preferring video or telephone appointments, responses were: all appointments face to face: 67%; half of appointments face to face and half via video/telephone: 26%; one face-to-face appointment for annual review and the rest video/telephone: 7%. As a result of this survey, service users can now specify their preference for their next appointment via the preclinic questionnaire, which is followed if clinically agreed.
