Diabetes Mellitus-Shared Care Model and ICT

The universe is fast changing the pace of events is massive. The app argonntly big world is shrinking into a global village as democracy spreads, western sandwich civilizations encroach on other civilizations and globalization obtains a household design. technological advancements and make betterments in the development and communicating technology put up perverted either spheres of human endeavor. While this is happening on one hand, health burster delivery has not improve signifi washbasintly. Many patients and clients complain of the miss of coordination in the health sector they be not happy about the decreased utility derived from health reverence facility they patronize.thither is a growing decrease in number of competent staff as considerably as insufficient fund for the health sector. These factors have made it necessary to tax the tinct of nurture and communication technology on health solicitude improvement. This regard has become more important for continuing affection where collaborationism between health dish out service providers is important. And with increasing incidence of chronic diseases and their attendant complications, this learn cannot be overemphasized. Besides, the cost of managing round of the chronic diseases, for theoretical account diabetes, epilepsy and seizure dis set ups, with the traditional method is reasonably high.The prospect ICT brings is meliorate tone of voice of wish due to collaboration between health boot workers with a comprehensive divided plow system adequately provide by ICT solutions and restrictd overall cost for the counsel of chronic diseases equivalent diabetes. In this paper, diabetes is the focalize chronic disease. I will attempt to label the requirements for an Irish ICT system to supply the model of divided up care. However, a draft review of diabetes mellitus and dual-lane care will be at a lower placetaken to unravel areas of focus for ICT intervention.Diabe tes 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 prevalently irreversible, and patients can have a reasonably normal lifestyle however its later(prenominal) complications which intromit macrovascular disease lead to change magnitude risk of develop coronary artery disease, peripheral vascular resistance and microvascular complications such as diabetic nephropathy, retinopathy and neuropathy.In a normal person, the assembly line glucose preoccupancy is narrowly accountantled in order to prevent the devastating complications that may follow rock-bottom or change magnitude affinity glucose concentration. This normal glucose aim is 80-90mg/100ml or 3. 5-5. 0mmol/l. This concentration usually increased to 120-140mg/100ml during the first hour after a glucose meal. The feedback utensil of the body is alerted to reduce this le vel to tolerable levels by the body by the conversion of glucose to animal starch for storage under hormonal influence particularly insulin.However, in the sobriety state, glucose is produced from glycogen and other substrates and released into the blood to maintain the blood glucose concentration. The various mechanisms for achieving this level of glucose subordination 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 metabolous organ that is important in the blood glucose modify system this is done by the storage of glycogen formed from glucose under the influence of insulin, a hormone produced by the pancreas, in the liver.It in any eccentric 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, insuli n is secreted from the Islet cells of Langerhans, the endocrine parcel out of the pancreas the insulin in turn causes the blood glucose concentration to decrease toward normal. Conversely a decrease in blood glucose concentration stimulates glucagon secretion the glucagon then 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 starvation or excessive drill of glucose during turn and other stressful situations, the glucagon mechanism likewise becomes valuable. Diabetes mellitus is a syndrome of impaired carbohydrate, fat and protein metabolism caused by either lack of insulin secretion or decreased sensitivity of the tissues to insulin.It could be primary or sanctionary primary diabetes is inherent magical spell 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 use, adrenal cortical steroid therapy, atypical antipsychotics, congenital lipodystrophy and acromegaly. There are two full general roles of diabetes mellitus eccentric I diabetes likewise called insulin- strung-out diabetes mellitus IDDM this is caused by lack of insulin secretion.Type II diabetes, overly called non-insulin dependent diabetes mellitus NIDDM is caused by decreased sensitivity of target tissues to the metabolic effect 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 uptake and utilization 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 fa ts and proteins increases.Injury to the important cells of the pancreas or diseases that impair insulin production can lead to type I diabetes. IDDM is repellent-mediated and has been associated with other autoimmune conditions like pernicious anaemia, alopecia areata and Hashimoto disease. Viral infections or autoimmune disorders may be involved in the remnant of of import 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, thither may be a hereditary tendency for beta cell degeneration even without viral infections or autoimmune disorders. The usual onset of type I diabetes occurs is less than 30 years 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 insulin, 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 put in type II diabetes mellitus.Type II diabetes mellitus is far more jet 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. long-sufferings with diabetes present with acute manifestations which include polyuria, polydipsia, weight freeing 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 plasma glucose 7. 0mmol/l, hit-or-miss plasma glucose 11. 1mmol/l routine investigations include urinalysis for protein and acetone, full blood count, urea and electrolytes, liver biochemistry and random lipids. Management of diabetes mellitus avenue for shared care The management of diabetes postulate comm social unity participation and patient education.The importance of glycemic control in the management of diabetic patient cannot be overemphasized patient should adequately understand the favorable outcome associated with good glycemic control, the tax write-off and concomitant complications that may result from poor plasma control. This is the core of ego management of diabetes. diligent should also know the dietetic requirement and comply with/adhere to do drugs use. Besides this self-care, community care is very essential as this constitutes family and general practitioner care. There is monitor of patients compliance to medications and dietary advice.Essentially, the management of diabetes is multidisciplinary dieticians, cardiologist, ophthalmologists, neurologists, internal medicine physicians, endocrine experts. There is growing need to integrate this range of practitioners. Metabolic control of diabetes can be tried and true by urine tests, home blood glucose testing and glycosylated hemoglobin. Urine tests are carried using 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 interact with specialist by appropriate communication facility for machine-controlled scheduling 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 spend i n Ireland where 59% of which is spent treating complications 50 countries endorsed measures to reduce diabetes complications by terzetto Shared financial aid What is shared care?Shared care is a concept where all the professionals involved in the management of a case collaborate by exchanging learning on the patients care. In this way, patient also has input into the care because his/her self-management better sure from the avalanche of nurture provided by the care earnings. Shared care is an approach to care where professionals share peg responsibility with regard to an individuals care using their skills and knowledge. It also talks about adequate monitoring and exchange of patient info within the limits of confidentiality and secrecy.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 forest, doorway and cost. Shared c are improves quality of patient care for patients with complex chronic disease like diabetes. There is increased access to patient data by health care professionals, and the patient can also easily access the professionals especially when the shared system is backed up by information and communication technology. Patient is also satisfied with the service rendered.This model has been suggested to be better than the stodgy method of intervention afforded to patients. The treatment is appropriate because the health care givers mark on best available method based on evidence- do. competence is also guaranteed and services are effective and efficient. On the hand, there is improved provider blessedness because there is reduced contact with the utilization of ordinal level of health care service. Definitions of impairment Self-management this is about goal-setting. It is the core of self management about medication and body care.Diabetic patients need to understand the implicati on of self care to monitor the progress of symptoms and emergence of complications. Home care monitoring is also very useful because it helps patients to monitor their response to treatment and glycemic control. Prevention primary prevention is important to reduce the possibility of a worsening condition especially for patients with multiple complex co-morbidities. residential area of practice this refers to the people involved in the share care. They include providers and organisations, citizens and patients with families and support groups.Models of shared care shared care is found in Primary Care which is the emphasis of The European Forum for Primary Care (EFPC), Secondary Care, Community Based Care and mental health. The focus of shared care includes inter-professional traffic and patient management. Inter-professional relations include cooperative provision of clinical services, communication and information exchange, use of treatment and referral guidelines, shared respons ibility for patient care, symmetric face to face contact, and joint professional education. Patient Management is based on individual patient goals.It includes patient and family in the decision making protocol of management and patient-centered focus. There is no rigid working modality with shared care, increased patient access to care reduced fragmentation of care and increased integration and continuity of care. There is a strong connecter 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 indispensable 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 hold 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 greens centre and sociable to the patient, their health care providers and researchers. The components include Clinical database this charters the information of patient. There is a central repository of health care information of the patient. It includes the electronic patient record which is but a segment of the repository.For diabetics, the information about their presentations, clinical features, investigations, treatment conceptions and modalit ies are combined, classified and ordered in get-at-able 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 support tool this is second important part of ICT solutions in shared care for diseases including diabetes. It contains specialized 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 internet has become the most influential means of connecting people, and exchanging information in this age. It is therefore domineering 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 importantly improves providers access to informationData storage since clinical database is an integral part of ICT solutions for shared care plan for diabetics. Data mustiness be stored in a way that is accessible to providers. This implies that strict measures and guidelines must be in plac e to ensure the database is well-structured. word of honor systems Websites must be secured. Database must be protected from intrusion by third party parties. Patients data must be confidential and kept private and guideline of medical ethics with respect to this must be maintained. Therefore a sophisticated intelligence network is imperative to accomplish this gargantuan task.E-learning for medical education there is need to provide facility for providers for reproduction 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 internet. Medicolegal/Ethic Issues ICT input into health care must be maintained within the limits of ethical guidelines and mediolegal regulations for data management, exchange and implementation. It addresses problems of populace interest, patient autonomy, third party involvement and inter national 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 affable 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, videophone to connect between car egivers and patients. both(prenominal) have proven useful in diabetic care. And this is widely report 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 in the lead initiating and implementing ICT input into shared care for diabetes. These include ? Confidentiality compromise ? Security breaches ? Territoriality and military unit 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. intensifier 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. Conclusion The impa ct 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 select and health care service will subsequently improve.