How many of you are actively engaging with their diabetes patients about sexual function, or more specifically erectile dysfunction, as we are now required to do for the quality and outcomes framework (QOF)?
About six weeks ago I had a patient new to our practice in for his annual review, and as I was going through all my normal discussion questions, I asked him “are you sexually actively currently and if so, do you experience any problems?”
Although initially taken aback by my direct approach, he agreed that he had got a problem, but would like to try and improve his blood sugars which were particularly high at that time, and see if that would make any difference.
Ten days ago, he visited me again, and on his list of questions to ask, was “is there something you can prescribe that will help with my sexual inadequacies?” We talked through the issue of erectile dysfunction and I sought to explain why it can be such a problem both with diabetes and the various drugs he might also be taking.
He left with a prescription for Sildenafil, at the lowest dose, as I explained he would not thank me for giving him the highest dose immediately, in case he reacted very strongly to it. I am waiting now to hear of the effect it has had, as being only in his 50s he would like to continue with an active sexual relationship with his wife of many years.
If we address this kind of issue openly and without embarrassment, our patients are less likely to become embarrassed themselves. Also if we raise the issue it makes things easier for them to ask us for help. The other key point we need to ensure we take care of, is referral of our newly-diagnosed patients to local structured education sessions.
In the Portsmouth area where I work, the system we use, we provide newly-diagnosed patients with contact details, such as the phone number of a diabetes centre locally, and arrange to attend a DESMOND (diabetes education and self-management for ongoing and newly diagnosed) day that is run by the specialist nurse team there.
For those of you who do not have access to these structured education sessions, they are an ideal way of patients obtaining the information they need in order to manage their diabetes. Often in general practice, we do not have sufficient time or opportunity to explain everything to our patients that they need to know.
I am amazingly fortunate in my practice, as I am allowed flexible amounts of time to see diabetes patients, whereas most practice are severely restricted in use of time. It is our responsibility to ensure that our patients are supported in every way possible, and group structured education is a great resource.
For those of you who follow my blog, I did not get the role with Diabetes UK, but am now quite relieved about that, looking at my ever increasing workload in practice and the need to possibly to increase my hours a little. Later in the year I will also commence my first module as part of my online Diploma in Diabetes, and I know that will be time-consuming.
Of course QOF targets have tightened up this year and more work will now be required for fewer points. I am seriously wondering how I will manage to get all my patients with Diabetes to see a dietician for a dietary (level 1 competence) review each year, as is now stated in QOF.
It is completely impossible to find enough dietician appointments for a few of my patients to see a dietician after diagnosis, how then will we manage to provide dietician’s appointments yearly for all on our diabetes register? Yes dietary review is of paramount importance in diabetes management, and I include it in the annual review, but there’s no dietician lurking who could see them each time, as might have been possible around ten years or so ago now.
Most of us will probably fall short on that target, but maybe we should use it as a challenge to ourselves to review our patients’ diets as often as possible.
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