Background There is increasing interest in how to successfully integrate care for people with Type 2 diabetes mellitus (T2DM), coordinating management between primary and secondary care. In Ireland, diabetes nurse specialists (DNSs) have been introduced into the community to facilitate a new model of integrated care where uncomplicated T2DM is managed in primary care, and complicated T2DM is managed between primary and secondary care. Our aim is to describe DNS service delivery in Ireland and examine regional variation in service implementation.
Methods Online questionnaires were administered by email to 150 DNSs, identified through various sources, including the Irish Diabetes Nurse Specialist Association, who asked members to register their contact details with the research team. The questionnaire, based on a UK survey adapted for the Irish health system, addressed the nurse’s clinical role, links with primary and secondary care, and referral access to support services. In open-ended questions, respondents outlined barriers and facilitators to diabetes management in their area. Fisher’s exact test was used to test differences across 4 regional networks of the Health Service Executive. A p-value of <0.05 (Bonferroni adjusted for multiple testing) was considered statistically significant. Open-ended questions (n = 86 respondents) were analysed using thematic analysis.
Results In total, 97 (64.6%) DNSs returned questionnaires. Almost all hospital (n = 62, 87.3%) and community nurses (n = 23, 95.8%) reported that patients with complicated T2DM attended their service. Although most (n = 86, 88.7%) had a liaison role with other professionals (GPs, Practice Nurses, DNSs, endocrinologists), less than half (n = 37, 39.2%) reported a formal agreement between primary and secondary care on how their service operates. While 92.8% (n = 90) could refer to other specialists, there were regional differences in access to psychologists and ophthalmologists (non-significant after adjustment). Barriers to service delivery included inadequate resourcing, limited guidance on the DNS role, and issues with integration, including GPs’ lack of engagement with community DNSs.
Conclusion Encouragingly, most community DNSs were seeing patients with complicated T2DM, as recommended under the national model of integrated care, with liaison part of the role for most respondents. However, the lack of formal agreements on DNS services across settings, regional issues with integration and referral access, indicate areas for attention as service changes continue. This includes the cycle of care which will remunerate GPs for primary care management of stable T2DM, and likely increase demand for DNS support in the community.
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