Revolutionising young adult diabetes care: a patient-centred transformation to improve access, engagement and outcomes in one of England's most deprived areas
Introduction: The transformation of our Young Adult Diabetes Service was driven by a patient-centred approach aimed at improving clinical outcomes and patient experience in one of the most deprived areas in England. The service faced significant challenges, including high ‘Did Not Attend’ (DNA) rate...
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| Main Authors: | , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2025-06-01
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| Series: | Future Healthcare Journal |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2514664525002103 |
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| Summary: | Introduction: The transformation of our Young Adult Diabetes Service was driven by a patient-centred approach aimed at improving clinical outcomes and patient experience in one of the most deprived areas in England. The service faced significant challenges, including high ‘Did Not Attend’ (DNA) rates, long waiting times, preventable emergency admissions and limited access to advanced diabetes technology. Our goal was to create a holistic, proactive care model that addressed these barriers, enhanced engagement and improved both safety and long-term outcomes. Materials and methods: We implemented data-driven, multidisciplinary interventions to optimise care delivery and reduce healthcare burdens1,2: • Reducing DNA rates: pre-appointment outreach by healthcare assistants reduced DNA rates from 50% to 18.1%, while follow-up waiting times decreased from 5.5 months to 3 months, boosting engagement and clinic efficiency. • Improving access: a dedicated email service and urgent access clinic allowed patients to bypass traditional appointment barriers, ensuring timely advice and intervention. • Preventing emergency admissions: early identification and personalised management plans reduced recurrent diabetic ketoacidosis (DKA) admissions by 80%, improving patient safety. • Expanding diabetes technology: 87.8% of patients now use continuous glucose monitoring (CGM), with most insulin pump users transitioning to hybrid closed-loop systems, improving glycaemic control and autonomy. • Continuous quality improvement: annual audits of nine key care processes maintained high standards, achieving a median HbA1c of 63 mmol/mol, among the best nationally. Eight of nine care processes exceeded national benchmarks, including 89.6% coverage for retinal screening and 80% for blood pressure monitoring. • Mental health integration3: CORE 10 screening, conducted every 4 months, identified 28% of patients with moderate to severe mental health concerns, enabling timely psychological referrals. • Enhancing patient engagement: pre-clinic questionnaires empowered patients to guide consultations, personalising care. Feedback showed that 93% of patients rated their experience as ‘very strongly positive’. • Seamless transition to adult services4,5: a dedicated transition clinic ensured continuity of care from paediatric to adult services, with patient feedback guiding continuous improvements. Results and discussion: The transformation led to significant improvements: • DNA rates for new patients reduced from 50% to 18.1%; • Follow-up waiting times decreased from 5.5 months to 3 months; • A median HbA1c of 63 mmol/mol, among the best nationally; • Eight of nine care processes exceeded national standards; • 28% of patients referred for psychological support following CORE 10 screening; • 93% of patients rated their care experience as ‘very strongly positive.’These outcomes highlight the effectiveness of a patient-centred, data-driven approach in achieving sustainable improvements. Conclusion: Our transformation has redefined young adult diabetes care by integrating advanced technology, prioritising mental health and improving access to timely support. This scalable, patient-centred model has not only enhanced clinical outcomes and patient satisfaction, but also addressed long-standing healthcare barriers. Recognised as a national best practice, including being highlighted at the recent Getting It Right First Time (GIRFT) national meeting,6 our approach serves as a framework for other NHS trusts looking to improve care for vulnerable populations and reduce health inequalities. Additionally, the service has contributed to a case study and narrative for NHS England, showcasing our innovative methods and impactful outcomes.7 |
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| ISSN: | 2514-6645 |