Quality Standards for Diabetes Care Toolkit

Guidelines

Type 1 diabetes management and multidisciplinary team approaches

The New Zealand Diabetes Workforce Service Review (2011) provides a diabetes care pathway for type 1 diabetes and states ‘the emphasis is on diabetes care being led and provided by specialist services particularly in the first month and year following diagnosis. On an ongoing basis specialist oversight is required but the majority of care may be provided in general practice with support from specialist services. Those with type 1 diabetes require long term care by a specialist multidisciplinary team with specific skills in managing all aspects of type 1 diabetes and its complications. Much of this care may be provided by nurse practitioners, specialist diabetes nurses and dietitians with expertise in type 1 diabetes and its complications. Other services will be required as the disease progresses and complications ensue, or for episodic care such as hospital admissions, travel plans, investigative procedure plans. Palliative care services are engaged at the appropriate stage and advanced care planning is embedded’ (p 18).
Ideally, the multidisciplinary care team should be co-located. Living with type 1 diabetes is challenging and the navigation of health care is complex with the need for appointments and partnerships with multiple providers.
The care pathway for children with type 1 can be found on page 53, and for adults aged over 18 years on page 54 (www.health.govt.nz/system/files/documents/pages/diabetes-workforce-service-review.pdf).
The National Institute for Health and Care Excellence (NICE) guidelines for people with type 1 diabetes are currently under review and will be finalised by August 2015. The 2004 guideline on diagnosis and management of type 1 diabetes in children, young people and adults is available here: www.nice.org.uk/Guidance/CG15.

Multidisciplinary teams

While there are no guidelines as such relating to teams, the following are requirements for a well-functioning multidisciplinary approach identified in a New Zealand report on multidisciplinary approaches in public health (Clewley et al 2005):

clarity about the role and expertise of each team member

a willingness to allocate tasks according to skills and joint responsibility for outcomes

regular and effective communication, enhanced where possible by collocation, joint case notes or information technology systems

support and ongoing education for team members

flexible funding and employment arrangements

rigorous and innovative research and evaluation into team processes, economic costs, and health outcomes with acknowledgement of the context in which the team operates

development of a common understanding of vision and goals: provides the common ground for members of a team. Ideally the vision and goals are arrived at collaboratively by team members

selecting the right team members: based not only on professional disciplines but also on appropriate skills and attitudes that are conducive to collaboration.
The report also identified the following obstacles to a multidisciplinary approach:

turf protection/gate-keeping

financial factors, eg, budget lines for ‘non-core’ work. Is the team funded as a separate entity (ie, budget line) or is funding drawn from the individual pre-existing budget lines of the professions/members involved?

lack of professional training in multidisciplinary approaches

logistics, eg, co-location, available meeting times, and physical resources

differing reporting requirements for disciplines involved

lack of formal evaluating criteria

lack of trust between participating professions

focus on professional autonomy

legislative framework limiting the scope of professional practice.