Diabetic Teams

Living with diabetes is difficult. There are many factors to consider and diabetes teams all over the country are trying to find ways to better manage their cohorts of patients.

With over 13.6 million people at risk of developing diabetes 2 (Diabetes UK stats) PKB can help a patient better self-management their diabetes by giving them access to personalised care plans. enriched with resources and information on how to track and manage their diabetes. Teams can reduce the need for face to face appointments and save money for the Trust.

Below are some workflows currently used by teams using PKB and a care plan explain.

Benefits

• Individual and group care plans

• Online resource library

• Secure messaging between patients & team

• Digitally appointment letters and appointments

• Access to laboratory results

• Symptom and measurement tracker

Example goal for using PKB

• To give patient's access to blood results and clinical documentation to help reduce phone calls to the service. Patients also have access to message Clinical Nurse Specialists with any queries.

• To give patient's access to blood results and clinical documentation to help reduce phone calls to the service. Patients also have access to message Clinical Nurse Specialists with any queries. Patients are given fit bits for a period of 6 weeks to track their steps to see if it makes a difference to their HBA1c levels.

Workflow for newly diagnosed diabetic patients

Newly diagnosed diabetic patients can benefit from having access to their PKB record, to support them to track their blood sugars, providing education and resources, access to their blood results, care plans and direct contact with their clinical team while they navigate their new diabetes.

Workflow for diabetic monitoring

Teams want patients to track and monitor any symptoms, measurements and blood results related to their diabetes using a care plan provided by the team.

Diabetes Annual Check Care Plan Template

Key objectives

Provide patients with information about their annual diabetes appointment and give patients a digital care plan to track and monitor symptoms related to their diabetes, support patient empowerment.

Outcome measures

Equip every patient with the information and advice to support the self-management of their diabetes. Educating them and giving them an escalation plan to follow when needed.

Current Baselines

All activity is face to face, with a lot of patients travelling large distances, where the follow-ups aren’t being efficiently or effectively managed.

Further information:

• Using a web-based PHR to build closer relationships with patients with Type 1 diabetes: investigates what extent a web-based personal health record system (PKB), could add value to diabetes care