Winocour P H, Gosden C, Walton C, Nagi D, Turner B, Williams R, James J, Holt R I G
Diabetes UK, London, UK.
Diabet Med. 2008 Jun;25(6):643-50. doi: 10.1111/j.1464-5491.2008.02449.x.
To identify the views and working practices of consultant diabetologists in the UK in 2006-2007, the current provision of specialist services, and to examine changes since 2000.
All 592 UK consultant diabetologists were invited to participate in an on-line survey. Quantitative and qualitative analyses of responses were undertaken. A composite 'well-resourced service score' was calculated. In addition to an analysis of all respondents, a sub-analysis was undertaken, comparing localities represented both in 2006/2007 and in 2000.
In 2006/2007, a 49% response rate was achieved, representing 50% of acute National Health Service Trusts. Staffing levels had improved, but remained below recommendations made in 2000. Ten percent of specialist services were still provided by single-handed consultants, especially in Northern Ireland (in 50% of responses, P = 0.001 vs. other nations). Antenatal, joint adult-paediatric and ophthalmology sub-specialist diabetes services and availability of biochemical tests had improved since 2000, but access to psychology services had declined. Almost 90% of consultants had no clinical engagement in providing community diabetes services. The 'well-resourced service score' had not improved since 2000. There was continued evidence of disparity in resources between the nations (lowest in Wales and Northern Ireland, P = 0.007), between regions in England (lowest in the East Midlands and the Eastern regions, P = 0.028), and in centres with a single-handed consultant service (P = 0.001). Job satisfaction correlated with well-resourced service score (P = 0.001). The main concerns and threats to specialist services were deficiencies in psychology access, inadequate staffing, lack of progress in commissioning, and the detrimental impact of central policy on specialist services.
There are continued disparities in specialist service provision. Without effective commissioning and adequate specialist team staffing, integrated diabetes care will remain unattainable in many regions, regardless of reconfigurations and alternative service models.
确定2006 - 2007年英国糖尿病专科顾问医生的观点和工作实践、当前专科服务的提供情况，并研究自2000年以来的变化。
邀请了英国所有592位糖尿病专科顾问医生参与一项在线调查。对回复进行了定量和定性分析。计算了一个综合的“资源充足服务评分”。除了对所有受访者进行分析外，还进行了一项子分析，比较了2006/2007年和2000年都有代表的地区。
2006/2007年，回复率达到49%，占急性国民医疗服务信托机构的50%。人员配备水平有所提高，但仍低于2000年提出的建议。10%的专科服务仍由单干的顾问医生提供，尤其是在北爱尔兰（在50%的回复中如此，与其他国家相比，P = 0.001）。自2000年以来，产前、成人与儿科联合以及眼科亚专科糖尿病服务和生化检测的可及性有所改善，但心理服务的可及性有所下降。近90%的顾问医生在提供社区糖尿病服务方面没有临床参与。自2000年以来，“资源充足服务评分”没有提高。有持续证据表明，不同国家之间（威尔士和北爱尔兰最低，P = 0.007）、英格兰不同地区之间（东米德兰兹和东部地区最低，P = 0.028）以及提供单干顾问医生服务的中心之间（P = 0.001）存在资源差异。工作满意度与资源充足服务评分相关（P = 0.001）。专科服务的主要担忧和威胁包括心理服务可及性不足、人员配备不足、委托工作缺乏进展以及中央政策对专科服务的不利影响。
专科服务提供方面仍存在持续差异。如果没有有效的委托工作和充足的专科团队人员配备，无论进行何种重新配置和采用何种替代服务模式，许多地区都无法实现综合糖尿病护理。
