Starting this month more than 6000 diabetes patients can count on well coordinated diabetes care by and between five Diabetes Care Groups, staffed by 75 family physicians in the region Almelo of the Netherlands.

Recently this group of family physicians signed a contract to this effect with Menzis, a large insurance provider in the Netherlands. The Diabetes Care Groups will start operating between April and June of 2007, with the goal to offer care to all diabetes patients in the region by September.

The diabetes care will be supported with disease management and chain care software provided by VitalHealth Software, while the implementation of the new care processes will be managed by Diagnosis4Health. As of today, several family physician practices are already operational within this new environment.

Diabetes Care Group
Approximately 75 of the 80 family physicians in the region Almelo have organized themselves into five Diabetes Care Groups. Two of these groups cover the Almelo region, one group covers Nijverdal-Hellendoorn, one covers a region called Twenteran-Tubbergen, and the fifth group covers Rijssen.

Within a Diabetes Care Group the family physician and assistant practitioner closely work together with a dietician, a diabetes specialist and nurse, and an ophthalmologist. The family physician ensures that the care for each diabetes patient is closely coordinated between these parties in the care group. To that effect, the team has access to a new Electronic Medical Record solution that is used consistently by all care providers throughout the care process. Later this summer, this EMR solution will also be made accessible by the patients themselves, allowing them to actively participate in their care.

Teamwork
Diabetes is a complex disease. For that reason, highly optimized teamwork between the care providers (and the patients) is essential to ensure quality care for diabetes patients. This will help avoid potential complications, such as congestive heart failure, blindness, foot ulcers, or the need for kidney dialysis.

Information
The Diabetes Care Groups base their internal communication en procedures on a new model for teamwork and chain care, supported by VitalHealth’s disease management software. This software is being implemented by D4H at participating family physician practices through training, as well as direct support during the initial hours of using the software for patient consultations. With more than four years of experience in working with over 600 family physician practices throughout the Netherlands, D4H has a established a proven track record in improving care for diabetes patients.