An initial assessment of the feasibility and effectiveness of implementingdiabetes shared care system in Taiwan - some experiences from I-Lan County

Diabetes is the fifth leading cause of death in Taiwan and the burden of su ffering is still increasing. Building a comprehensive and efficient health care system is crucial to improve the outcome of the diabetics. We implemen ted the first diabetes shared care system of Taiwan in I-Lan County since A ugust 1996 under the support of Department of Health, the Executive Yuan. T his county-wide system was named 'Lan-Yang Diabetes Shared Care System' by the regional steering committee. Regional guidelines for diabetes managemen t were developed after extensive discussion. A multidisciplinary diabetes c are team was organized through a training and certification process. Regist ered patients held diabetes passports to keep clinical record. Physicians o f the system use shared referral protocols and sheets. By the end of June 1 999, 99 medical professionals had completed their training for diabetes sha red care and been certified. The shared care system awarded 26 clinics to h ang the lamp signs with the system logo to make them distinguishable. Stich clinics have now been available throughout 12 townships in I-Lan County. T he number of registered patients carrying diabetes passport increased to 34 84 and there was a community-based patient group in every township of I-Lan County. The amount of continuing diabetes clinical training delivered by t he specialists to the primary care physicians and non-physician professiona ls increased to 1681 person-hours per year. The proportion of registered pa tients undertaking fundus examination within I year increased to 30.9%, che cking urine micro-albumin to 28.0% and checking HbA(1c) 72.8%, respectively . Mean HbA(1c) value decreased from 8.7% in the first year to 7.9% in the t hird year. Our study showed that under the co-ordination by regional health bureau with integration of different levels of medical facilities, governm ental sectors and non-governmental community resources, the diabetes shared care model is feasible in Taiwan. Through its implementation, quality of r egional diabetes care has achieved preliminary improvement. (C) 2001 Elsevi er Science Ireland Ltd. Aff rights reserved.