title: Redesigning an intensive insulin service for patients with type 1 diabetes: a patient consultation exercise.
abstract: BACKGROUND
  Providing effective support for patients in using insulin effectively is essential for good diabetes care. For that support to be effective it must reflect and attend to the needs of patients.
  
  
  OBJECTIVE
  To explore the perspectives of adult type 1 diabetes patients on their current diabetes care in order to generate ideas for creating a new patient centered intensive insulin clinic.
  
  
  METHODS
  A multi-method approach was used, comprising: an observational exercise of current clinical care; three focus groups (n = 17); and a survey of service users (n = 419) to test the ideas generated from the observational exercise and focus groups (rating 1 to 5 in terms of importance). The ideas generated by the multi-method approach were organized thematically and mapped onto the Chronic Care Model (CCM).
  
  
  RESULTS
  THE THEMES AND PREFERENCES FOR SERVICE REDESIGN IN RELATION TO CCM COMPONENTS WERE: health care organization, there was an interest in having enhanced systems for sharing clinical information; self-management support, patients would like more flexible and easy to access resources and more help with diabetes technology and psychosocial support; delivery system design and clinical information systems, the need for greater integration of care and better use of clinic time; productive relationships, participants would like more continuity; access to health professionals, patient involvement and care planning. The findings from the patient survey indicate high preferences for most of the areas for service enhancement identified in the focus groups and observational exercise. Clinical feedback and professional continuity (median = 5, interquartile range = 1) were the most highly rated.
  
  
  CONCLUSIONS
  The patient consultation process had generated important ideas on how the clinical team and service can improve the care provided. Key areas for service development were: a stronger emphasis of collaborative care planning; improved patient choice in the use of health technology; more resources for self-management support; and a more explicit format for the process of care in the clinic.
authors.affiliation: Department of Medical Nursing, Florence Nightingale Nursing Faculty, Istanbul University, Istanbul, Turkey ; Department of Primary and Intermediate Care, Florence Nightingale School of Nursing and Midwifery, King's College London, London, United Kingdom ; Department of Diabetes, King's College Hospital NHS Foundation Trust, London, United Kingdom.
authors.forename: Seyda
authors.initials: S
authors.lastname: Ozcan
authors.forename: Helen
authors.initials: H
authors.lastname: Rogers
authors.forename: Pratik
authors.initials: P
authors.lastname: Choudhary
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Amiel
authors.forename: Alison
authors.initials: A
authors.lastname: Cox
authors.forename: Angus
authors.initials: A
authors.lastname: Forbes
keywords: intensive insulin treatment; patient feedback; quality improvement; service development; type 1 diabetes