Report of the 1994 BPA/BDA survey of services for children with diabetes: changing patterns of care

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Abstract
The results of a 1994 survey of consultant paediatricians in the UK were compared with those of a 1988 survey to assess how the organization of services for children with diabetes had changed. We found evidence of a substantial improvement, in line with the recommendations of the 1988 BPA Working Party Report on the Organization of Services of Children with Diabetes. Key features of this improvement included a service rationalization with fewer consultants (325 versus 360) providing care for more children: 45 % with a clinic size of over 40 children compared with 23 % in 1988. More consultants saw children in a designated paediatric clinic (88 % compared with 63 %) and expressed a special interest in diabetes (48 % compared with 32 %). Eighty‐seven % of consultants had a diabetes nurse specialist regularly attending the clinic (vs 61 % in 1988) and 91 % (vs 75 %) reported that a dietitian attended regularly. Although more consultants had a psychologist or psychiatrist attending the clinic, these specialists remained a scarce resource (20 % compared with 9 % in 1988). Continuing deficiencies in the quality of service for some children were identified with small cohorts of children being managed in general paediatric clinics with inadequate expert support staff; there was a widespread shortage of diabetes nurse specialists and only 30 % of those in post worked full time with children. In addition 52 % of consultants expressed no special interest in diabetes and 10 % did not regularly monitor glycated proteins. Continuing improvement of services for children with diabetes in the UK is needed. © 1997 by John Wiley & Sons, Ltd.