Transcript GP 4001 Lecture 6

Dealing with
chronic illness in
general practice
What are the main
issues for a GP caring
for a a patient with
diabetes mellitus in
the community?
The main issues in
diabetes care I
• Is the diagnosis right?
• What’s the glycaemic control like?
• What treatment does the patient need?
• Is the BMI optimal?
• Are cardiovascular risks identified and
controlled?
• Are there any complications present?
The main issues in
diabetes care II
• What does the patient know/
understand about diabetes?
• What does the patient need to be told?
• Is the patient receiving all the care
required for her condition?
• What follow up is required and is it
adequately arranged?
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Checklist for care of people
with diabetes
Blood glucose (fasting)
HbA1 or fructosamine
Body Mass Index
Blood Pressure
Fundi
Feet
Renal function –albinuria/ proteinuria/ creatinine
clearance
Smoking status
Lipids
Adherence to treatment & diet
Immunizations – Pneumococcal, influenza
Drug treatments for patients
with diabetes
• Metformin
• Sulphonylureas
• Meglitinides
• Glitizones
• Anti-platelet drugs
• Lipids control – statins, fibrates
• ACE inhibitors/ ARBs
The GP’s role
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Confirm the diagnosis (sometimes)
Devise a management plan
Implement the management plan
Recruit & co-ordinate all the resources needed
to execute the management plan (team effort)
Monitor progress of the disease
Monitor the effects of the treatment
Ensure attention to all dimensions of the
problem - physical, psychological, social,
spiritual etc.
Patient advocate
Doris has diabetes, it’s type two
So what now must her doctor do?
She must check her for this and
that
And make sure that she knows
what is what
For next lecture
Write out a checklist/ template
for the issues that need to be
covered in a set of guidelines
for the management of any
chronic disease in the
community