Winocour P H, Mearing C, Ainsworth A, Williams D R R
Queen Elizabeth II Hospital, East and North Hertfordshire NHS Trust, Welwyn Garden City, Herts, UK.
Diabet Med. 2002 Jul;19 Suppl 4:39-43. doi: 10.1046/j.1464-5491.19.s4.7.x.
To examine the provision of, and variations in, dietetic services for diabetes in secondary care in the UK.
A postal survey of all secondary care providers of diabetes services.
There was a 77% response rate. A dedicated dietician supported diabetes services in 73% of responses, but only 45% were able to see newly diagnosed patients within 1 month. Only 3% of responses documented that dietetic services provided the recommended minimum 22 h weekly input to diabetes care, and an annual dietetic review was said to be available in 15%. An opportunity for more frequent visits was most likely if there was poor glycaemic control (78% of responses), particularly when services were provided by a dedicated diabetes dietician. Although dieticians frequently provided input to patient education (88%), specific training for this purpose and provision for continuing education of these individuals was less common (14% and 63%, respectively). Nutritional guidelines were available in 74%, but only 31% of responses documented current guidelines on obesity management. Of bids for additional dietetic resources, only 21% had been successful. There was evidence of regional variation in service provision, and no greater provision of dietetic services in areas with a large South Asian population and an expected high prevalence of diabetes. In broad terms, dietetic services for diabetes care had not altered in comparison with a similar survey in 1997.
The level of dietetic support of secondary care diabetes services remains dramatically lower than recommended in advisory documents, and appears to have changed little over the last 3 years. This is compounded by marked regional differences, and was no better in areas with a higher than average prevalence of diabetes. The survey also highlights the need for more co-ordinated and structured education and training of dieticians as well as more consistency in nutritional guidelines.
研究英国二级医疗保健机构中糖尿病饮食服务的提供情况及差异。
对所有提供糖尿病服务的二级医疗保健机构进行邮政调查。
回复率为77%。73%的回复表示有专门的营养师为糖尿病服务提供支持，但只有45%的机构能够在1个月内为新诊断患者提供服务。只有3%的回复记录显示饮食服务为糖尿病护理提供了建议的每周至少22小时的投入，15%的回复称有年度饮食评估。如果血糖控制不佳（78%的回复），尤其是由专门的糖尿病营养师提供服务时，患者最有可能获得更频繁就诊的机会。尽管营养师经常为患者教育提供投入（88%），但为此目的的专门培训以及为这些人员提供继续教育的情况较少见（分别为14%和63%）。74%的机构有营养指南，但只有31%的回复记录了当前关于肥胖管理的指南。在申请额外饮食资源的情况中，只有21%获得成功。有证据表明服务提供存在地区差异，在南亚人口众多且预计糖尿病患病率较高的地区，饮食服务的提供并没有更多。总体而言，与1997年的类似调查相比，糖尿病护理的饮食服务没有变化。
二级医疗保健糖尿病服务的饮食支持水平仍远低于咨询文件中的建议，并且在过去三年中似乎变化不大。这因明显的地区差异而更加复杂，在糖尿病患病率高于平均水平的地区情况也没有更好。该调查还强调了对营养师进行更协调、结构化教育和培训的必要性，以及营养指南更具一致性的必要性。
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