2016 № 2 Analysis of the official regulation documents on organization of outpatient care for patients with chronic complications of diabetes mellitus
Diabetes mellitus (DM) is a socially important chronic disease with the disabling and economically significant complications. Organization of specialized structures for interdisciplinary out-patient care for patients with chronic complications of diabetes (affecting kidneys, eyes, the lower extremities) is an important task. We analyzed existing National clinical expert recommendations and orders of Ministry of Health concerning standards of care for patients with DM and its complications. Conclusions are drawn on necessary development of the regulatory documentary base for out-patient multidisciplinary care for this kind of patients.
2016 № 1 Chronic complications of diabetes mellitus: specialized outpatient medical service organization and efficacy according to experts’ opinion survey
Multidisciplinary outpatient care structures for patients with late complications of diabetes (diabetic foot, retinopathy, and somewhere – for diabetic nephropathy) were established in Russia since late 1990s. We conducted a survey of 22 experts from 12 regions of the Russian Federation for the analysis of the current state of specialized outpatient care for patients with these conditions, assess demand in this type of care and develop possible improvements. The necessity of outpatient diabetic foot clinics was obvious for 100% of the experts, of diabetic retinopathy consultative rooms – for 95%, of diabetic nephropathy consultative rooms – for 52%. Eighty five percent, 52% and 15% of the experts respectively reported about work of such outpatient structures in their regions. In all three fields lack of funding and lack of qualified personnel were pointed as the main barriers for establishment and development of such outpatient structures. The efficacy of patients treatment in outpatient diabetic foot clinics (where they work) was considered an effective by 47% of experts, in diabetic retinopathy consultative rooms – by 55%. In conclusion, (1) the demand in outpatient diabetic foot and diabetic retinopathy specialized structures is obvious, but is questionable with regard to diabetic nephropathy; (2) the performance of these service is not sufficiently high, which requires appealing of qualified specialists there (which is impossible without adequate funding), training of specialists and quality management; (3) we found evidence of inadequate availability of such specialized outpatient care for patients with diabetes, which requires increase of such offices number, and targeted referral of patients there from primary care physicians.