Sue Roberts

Long-term biomedical and psychosocial outcomes following DAFNE (Dose Adjustment For Normal Eating) structured education to promote intensive insulin therapy in adults with sub-optimally controlled Type 1 diabetes

AIMS To explore long-term outcomes of participation in a Dose Adjustment For Normal Eating (DAFNE) training course, which provided one-off exposure to structured education in intensive insulin therapy to people with established Type 1 diabetes. METHODS A cohort design follow-up of original trial participants at a mean of 44 months (range: 37-51 months) in hospital diabetes clinics in three English health districts. 104 (74%) original participants provided biomedical data; 88 (63%) completed questionnaires including the ADDQoL, measuring impact of diabetes on quality of life (QoL). RESULTS At 44 months, mean improvement in HbA(1c) from baseline was 0.36% (9.32+/-1.1% to 8.96+/-1.2%, p<0.01) remaining significant but deteriorated from 12 months (p<0.05). Improvements in QoL seen at 12 months were sustained at 44 (e.g. impact of diabetes on dietary freedom: -1.78+/-2.33 at 44 months versus -4.27+/-2.94, baseline, p<0.0001; versus 1.80+/-2.32 at 12 months, ns). Similar results were obtained using last observation carried forward for patients not supplying follow-up data. CONCLUSIONS The impact of a single DAFNE course on glycaemic control remains apparent in the long term, although further interventions will be required to achieve recommended HbA(1c). In contrast, improvements in QoL and other patient-reported outcomes are well maintained over approximately 4 years.

Delivering person centred care in long term conditions

Transforming care for people with long term conditions, including support for self management, requires comprehensive reform of health systems largely geared to provide acute care. Simon Eaton, Sue Roberts, and Bridget Turner explore the barriers to change, arguing that the success of new approaches will depend on whole system change and strong leadership

Care planning for long-term conditions – a concept mapping

This article focuses on approaches within clinical practice that seek to actively involve patients with long‐term conditions (LTCs) and how professionals may understand and implement them. Personalized care planning is one such approach, but its current lack of conceptual clarity might have impeded its widespread implementation to date. A variety of overlapping concepts coexist in the literature, which have the potential to impair both clinical and research agendas. The aim of this article is therefore to explore the meaning of the concept of care planning in relation to other overlapping concepts and how this translates into clinical practice implementation.

Year of Care: the key drivers and theoretical basis for a new approach in diabetes care

The Year of Care initiative aims to transform the annual review into a collaborative care planning consultation based on a partnership approach. It has been piloted across three centres in England.

House of care approach for patients with long term conditions works at the local level.

As members of the Year of Care team that developed the “house of care” we welcome Watt’s editorial on the challenge of multimorbidity.1 Although he correctly states that the original Year of Care pilot programme focused on diabetes, this was simply a starting point. Subsequently, as intended, we have helped various health communities to extend the learning and experience to people with other …