Virtual Clinic - an Evaluation of a DNE Phone Titration Program — ASN Events
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Virtual Clinic - an Evaluation of a DNE Phone Titration Program (#404)

Susan Neuner 1 , Marion Hawker 1 , Rosalie Arnold 1 , Michelle Kriss 1 , Shamasunder H Acharya 2 , Siddharth Acharya 3
  1. Greater Newcastle Sector Diabetes Service, Hunter New England Local Health District, Newcastle, NSW, Australia
  2. Medicine / Endocrinology, John Hunter Hospital, Newcastle, NSW, Australia
  3. Newcastle Grammar School, Newcastle, NSW, Australia

Background: Insulin titration is an integral part of optimal diabetes management, however it requires frequent consultations. Face to face appointments can be problematic for patients who are distant from clinics, without transport or who have difficulty getting time away from work or family commitments. Prior to the Telephone Titration Program (TTP), patient's insulin adjustments were managed in busy multidisciplinary clinics. The TTP, led by Diabetes Nurse Educators (DNE), has served more than 800 patients since 2012, offering the opportunity for more frequent, comprehensive and convenient patient review, efficiently facilitating problem solving of issues as they arise.
Aims: To evaluate the effectiveness of the TTP to optimise glycaemic control, improve the experience of care and reduce both patient and health service costs.
Method: An audit of a random sample of 46 patients referred to the program (January 2013-May 2014, n= 333) was conducted. Data was collected at referral, during the titration period, and up to 12 months prior to and after discharge. The data included weight, HbA1c, insulin dose changes and specialist team appointments. Additionally, feedback regarding the conduct and acceptability of the clinic was sought from a sample of patients (n=15) and clinical staff (n= 8).
Results: The table shows the results of the audit (n=46).

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An average of 3 patient phone calls with the DNE (range 1-12) were made. Only 5 (10.8%) patients reported more than 2 hypoglycaemic levels and 28 (60.9%) achieved fasting and 29 (63.9%) post-prandial targets during the titration period. Thirteen (28.3%) were new to insulin therapy. On average, each patient saved 128Km travel, $96 and 4.75hours of time. The total 5890Km travel savings for 46 patients translates to 1000Kg CO2 emissions saved. Patient and clinician satisfaction with the program was positive.

Conclusion:
Phone titration is an acceptable, cost effective and safe method of adjusting insulin for patients new to or on existing insulin therapy, reducing travel time and costs. This clinic has led to a decreased demand for Diabetes Specialist Team appointments, which  has impacted positively on waiting times for new patients referred to the Diabetes Service.