Diabetes Mellitus-Shared Care Model and ICT

The world is fast changing the pace of events is massive. The app argonntly queen-sized world is shrinking into a global village as res publica spreads, western civilizations encroach on other civilizations and globalization becomes a syndicate concept. Technological advancements and improvements in the cultivation and converse engine room throw twisted all spheres of human endeavor. While this is happening on one hand, wellness deal out de colorfuly has not conk out signifi seattly. Many affected roles and clients complain of the wish of coordination in the health sector they are not happy well(p)-nigh the reduce utility derived from health carry off facility they patronize.There is a growth reduction in number of competent staff as well as insufficient fund for the health sector. These factors have do it needful to evaluate the impact of nurture and communion technology on health bid swear out. This need has become more than important for inveterate unhea lthiness where collaboration amid health kick service providers is important. And with increasing intercourse incidence of inveterate diseases and their attendant complications, this need rear endnot be overemphasized. Besides, the embody of managing close to of the chronic diseases, for example diabetes, epilepsy and seizure disorders, with the traditional method is reasonably high.The prospect ICT brings is change quality of subscribe to do due to collaboration between health sustenance workers through a comprehensive divided oversee system adequately powered by ICT solutions and reduced overall cost for the commission of chronic diseases equivalent diabetes. In this paper, diabetes is the focus chronic disease. I ordain blast to evaluate the requirements for an Irish ICT system to supply the model of coverd explosive charge. However, a brief review of diabetes mellitus and shared vex exit be undertaken to ravel out areas of focus for ICT intervention.Diabete s mellitus Review Diabetes mellitus is a syndrome of chronic hyperglycemia due to relative or absolute insulin deficiency, resistance or both. It affects over 100million people worldwide. Diabetes is ordinarily irreversible, and long-suffering roles peck have a reasonably ordinary lifestyle in time its later complications which include macrovascular disease lead to increased risk of go coronary artery disease, circumferential vascular resistance and microvascular complications such as diabetic nephropathy, retinopathy and neuropathy.In a normal person, the caudex glucose concentration is narrowly discoverled in order to prevent the devastating complications that may follow reduced or increased prodigal glucose concentration. This normal glucose level is 80-90mg/100ml or 3. 5-5. 0mmol/l. This concentration unremarkably increased to 120-140mg/100ml during the first hour after a glucose meal. The feedback instrument of the soundbox is alerted to reduce this level to tolera ble levels by the body by the passage of glucose to glycogen for storage under hormonal influence particularly insulin.However, in the fasting state, glucose is produced from glycogen and other substrates and released into the telephone line to maintain the blood glucose concentration. The dissimilar mechanisms for achieving this level of glucose control are as a result of hormonal influence, the activities of organs such as liver, skeletal muscle and the particular glucose concentration. The liver is a major metabolic organ that is important in the blood glucose buffer system this is done by the storage of glycogen form from glucose under the influence of insulin, a hormone produced by the pancreas, in the liver.It excessively releases glucose into the blood in the fasting state. Insulin and glucagon function as important feedback control systems for maintaining a normal blood glucose concentration. When the glucose concentration rises too high, insulin is secreted from the Isl et cells of Langerhans, the ductless gland portion of the pancreas the insulin in turn ca mappings the blood glucose concentration to decrease toward normal. conversely a decrease in blood glucose concentration stimulates glucagon secretion the glucagon hence functions in the opposite direction to increase the glucose concentration toward normal.Under most normal conditions, the insulin feedback mechanism is much more important than the glucagon mechanism, but in instances of famishment or excessive economic consumption of glucose during exercise and other stressful situations, the glucagon mechanism in any case becomes valuable. Diabetes mellitus is a syndrome of impaired carbohydrate, fat and protein metabolism caused by each leave out of insulin secretion or decreased sensitivity of the tissues to insulin.It could be pristine or secondary primary diabetes is inherent while secondary diabetes can be due to Cushing syndrome, pheochromocytoma, cystic fibrosis, chronic pancre atitis, malnutrition-related pancreatic disease, pancreatectomy, and hereditary hemochromatosis, carcinoma of the pancreas, thiazide diuretic drug use, corticosteroid therapy, atypical antipsychotics, congenital lipodystrophy and acromegaly. There are two customary examples of diabetes mellitus pillowcase I diabetes withal called insulin-dependent diabetes mellitus IDDM this is caused by lack of insulin secretion.Type II diabetes, also called non-insulin dependent diabetes mellitus NIDDM is caused by decreased sensitivity of fundament tissues to the metabolic termination of insulin. This reduced sensitivity to insulin is often referred to as insulin-resistance. The basic effect of insulin lack or insulin resistance on glucose metabolism is to prevent the efficient inspiration and go for of glucose by most cells of the body, except those of the brain. As a result, blood glucose concentration increases, cell utilization of glucose falls increasingly lower and utilization of f ats and proteins increases.Injury to the genus Beta cells of the pancreas or diseases that impair insulin production can lead to type I diabetes. IDDM is immune-mediated and has been associated with other autoimmune conditions like pernicious anaemia, alopecia areata and Hashimoto disease. viral infections or autoimmune disorders may be compound in the last of beta cells in many patients with type I diabetes, although heredity also plays a major role in determining the susceptibility of the beta cells to destruction by these insults. HLA-DR3 or DR4 is found in more than 90% of patients.In some instances, at that place may be a hereditary temperament for beta cell degeneration even without viral infections or autoimmune disorders. The usual encroachment of type I diabetes occurs is less than 30 historic period this is why it is called juvenile-onset diabetes mellitus. Type II diabetes mellitus is caused by diminished sensitivity of target tissues to the metabolic effects of ins ulin, a condition referred to as insulin resistance. This syndrome, like Type I diabetes mellitus is associated with multiple metabolic abnormalities although high levels of keto-acids are usually not present in type II diabetes mellitus.Type II diabetes mellitus is far more common that type I, accounting for 80-90% of all cases of diabetes mellitus. In most of these cases, the onset of type II diabetes mellitus occurs after age 40. There is usually no immune disturbance. Therefore, this syndrome is often referred to as adult-onset diabetes mellitus. Patients with diabetes present with acute manifestations which include polyuria, polydipsia, cant loss and ketonuria they also present with subacute symptoms like lethargy, reduced exercise tolerance, vulvar pruritus, and visual disturbance.They also could also present with some of the complications of the disease such as staphylococcal disease, retinopathy, polyneuropathy, erectile dysfunction and peripheral neuropathy. Investigations that are necessary in the diagnosis of diabetes mellitus include fasting blood plasma glucose >7. 0mmol/l, random plasma glucose >11. 1mmol/l routine investigations include urinalysis for protein and acetone, wide blood count, urea and electrolytes, liver biochemistry and random lipids. Management of diabetes mellitus avenue for shared apprehension The management of diabetes requisite community participation and patient education.The splendour of glycemic control in the management of diabetic patient cannot be overemphasized patient should adequately conceive the favorable outcome associated with goodish glycemic control, the implication and serial complications that may result from poor plasma control. This is the essence of self management of diabetes. Patient should also know the dietary requirement and comply with/ bond to drug use. Besides this self-care, community care is very essential as this constitutes family and general practitioner care. There is monitoring of patients residency to medications and dietary advice.Essentially, the management of diabetes is multidisciplinary dieticians, cardiologist, ophthalmologists, neurologists, internal medicine physicians, endocrine experts. There is developing need to integrate this range of practitioners. Metabolic control of diabetes can be tested by urine tests, home blood glucose testing and glycosylated hemoglobin. piddle tests are carried victimisation dipsticks these methods are simple and give a good feedback on the blood glucose control. Patients can also be taught finger-prick and use blood glucose monitoring device to measure blood glucose.They can then act with specialist through bewitch communication facility for automated programing and medication. Epidemiologically, there are 200,000 persons in Ireland with diabetes this figure represents 3-5% of western populations. It is estimated to double by 2010. It consumes 10% of total health budgets. About 350 million annual cost is s pent in Ireland where 59% of which is spent treating complications 50 countries endorsed measures to reduce diabetes complications by one-third Shared Care What is shared care?Shared care is a concept where all the professionals involved in the management of a case collaborate by exchanging information on the patients care. In this representation, patient also has input into the care because his/her self-management better informed from the avalanche of information provided by the care network. Shared care is an approach to care where professionals share joint responsibility with respect to an individuals care using their skills and intimacy. It also talks about adequate monitoring and metamorphose of patient data within the limits of confidentiality and privacy.Shared care is both systemic and local it collaborates the systems involved while there is local interaction between clinicians. Shared care impacts on the iron triangle of health. This triangle includes quality, access an d cost. Shared care improves quality of patient care for patients with complex chronic disease like diabetes. There is increased access to patient information by health care professionals, and the patient can also easily access the professionals peculiarly when the shared system is backed up by information and communication technology. Patient is also snug with the service rendered.This model has been suggested to be better than the conventional method of treatment afforded to patients. The treatment is appropriate because the health care givers agree on best visible(prenominal) method ground on evidence- act. Competence is also guaranteed and services are effective and efficient. On the hand, there is improved provider satisfaction because there is reduced contact with the utilization of tertiary level of health care service. Definitions of terms Self-management this is about goal-setting. It is the core of self management about medication and body care.Diabetic patients need t o understand the implication of self care to monitor the progress of symptoms and emergence of complications. hearth care monitoring is also very useful because it helps patients to monitor their repartee to treatment and glycemic control. Prevention primary prevention is important to reduce the supposition of a worsening condition especially for patients with multiple complex co-morbidities. companionship of practice this refers to the people involved in the share care. They include providers and organisations, citizens and patients with families and co-occurrence groups.Models of shared care shared care is found in particular Care which is the tension of The European Forum for Primary Care (EFPC), vicarious Care, Community Based Care and mental health. The focus of shared care includes inter-professional relations and patient management. Inter-professional relations include cooperative provision of clinical services, communication and information exchange, use of treatmen t and referral guidelines, shared responsibility for patient care, regular face-to-face contact, and joint professional education. Patient Management is based on individual patient goals.It includes patient and family in the decision make protocol of management and patient-centered focus. There is no rigid working humour with shared care, increased patient access to care reduced fragmentation of care and increased integration and continuity of care. There is a crocked link at all levels of health sector-improved working relationships between providers and improved satisfaction among patients and providers. Diabetes-shared care-ICT solutions There is no doubt that information and communication technology is inevitable in the management of chronic diseases like diabetes.In order to set-up an Irish ICT unit for diabetes, the requirements will be considered within the limit of the community of practice which includes providers and organization, citizens and patients. The concept of ICT solutions is branded as eHealth. It is a promising field that will incorporate all the professionals who are directly and indirectly involved in the management of a case to properly integrate their knowledge and skills for the appropriate care of a diabetic patient while making the emphasis glycemic control convenient for providers and patients.It is imperative to elucidate the aspect of health care that are relevant to ICT input the idea of ICT use is to integration of information to improve access. This implies that patients information are made available at a common centre and accessible to the patient, their health care providers and researchers. The components include clinical database this contains the information of patient. There is a rudimentary repository of health care information of the patient. It includes the electronic patient record which is but a particle of the repository.For diabetics, the information about their presentations, clinical features, investigati ons, treatment plans and modalities are combined, classified and coherent in accessible manner at the clinical database centre. This database centre is secured as the confidentiality and privacy of the patients data has to be maintained. It is also prevented from use by third parties unless there is due consent by the patient. This central unit is fed by local diabetes databases from local hospitals. The data is made accessible to general practitioners, community health care providers and patients.Decision backup pawn this is second important part of ICT solutions in shared care for diseases including diabetes. It contains change information guide for experts and simple algorithms of decisions for patients. Specific Requirements Providers and organization The tools that are required to have an effective shared care plan for diabetes includes Internet the cyberspace has become the most influential means of connecting people, and exchanging information in this age. It is wherefor e unequivocal that it is useful in health information systems to achieve a collaborative network of professionals who care for diabetic patients.A large bandwidth is required for the volume of information that is processes, exchanged and implemented in shared care practice for diabetic patients. Interprofessional Communication systems Diabetic care requires effective interdisciplinary communication so that management decision is both cost-effective and evidenced based. A huge communication network is therefore required. Mobile and wireless infrastructure these also form ICT tools which are used in database processing, exchange and monitoring, they are required in order to facilitate the integration of the patient, and more significantly improves providers access to informationData storage since clinical database is an integral part of ICT solutions for shared care plan for diabetics. Data essential be stored in a way that is accessible to providers. This implies that strict measu res and guidelines must be in place to chequer the database is well-structured. Intelligence systems Websites must be secured. Database must be protected from invasion by third party parties. Patients data must be confidential and kept private and guideline of medical ethical motive with respect to this must be maintained. Therefore a sophisticated scholarship network is imperative to accomplish this gargantuan task.E-learning for medical education there is need to provide facility for providers for training and retraining. They need to update their knowledge base so that thy can offer quality service to clients. This can be achieved by making such up-to-date information available through an accessible means, for instance, the meshwork. Medicolegal/Ethic Issues ICT input into health care must be maintained within the limits of ethical guidelines and mediolegal regulatings for data management, exchange and implementation. It addresses problems of public interest, patient autonom y, third party involvement and international regulation against threats.Citizens and Patients The requirements for the patients include E-learning device for the patient this will teach patient the modus operandi of the collaborative health information system, their role and why it is important they adopt it. It will also give useful information about diabetes. Decision support tools this should contain factual information that can guide the patient to make informed choice with respect to their management. Patient home management this includes clinical signs monitoring, automated scheduling and medication.It also comprises access to health educators and professionals. Areas of ICT use have been well documented in the literature they are basically Teleconsultation this is a kind of telemonitoring between patient and caregiver via phone, email, automated messaging tools and the internet Videoconferencing this is face-to-face contact via such equipments as television, digital camera, v ideophone to connect between caregivers and patients. Both have proven useful in diabetic care. And this is widely reported in many papers from across the world. Issues and challengesHaving elucidates the conditions above in terms of providers and patients it is needful to quickly mention that certain issues must be considered before initiating and implementing ICT input into shared care for diabetes. These include ? Confidentiality compromise ? security department breaches ? Territoriality and power status amongst health care providers ? Cost of ICT requirements ? Medicolegal issues These challenges will adversely affect ICT adoption for shared car in diabetes if ignored. They can be addressed by ? Adequate funding of the project by government.Intensive training for users and health care professionals ? Consensus on the modus operandi amongst health care service providers ? Intensive research into ICT implications in health care, patients behavior, pragmatism of project plan. fi nal stage The impact of ICT on shared care plan for diabetes is indispensable. There are improved collaboration amongs health care workers and patients are ultimately satisfied with the service they get. The requirements for Irish ICT have been elucidated and concomitant issues explained. It is my hope that this will be adopted and health care service will subsequently improve.