Five questions with Professor Juliana Chan

Professor Chan, Assistant Dean at the Chinese University of Hong Kong, Prince of Wales Hospital (CUHK-PWH), joins us in this quarter's IDF Newsletter to share more information on one of the newest Centres of Education to join IDF’s growing network.

1. Tell us about your institution? Why did you decide to join IDF's Centres of Education Network (IDFCE)?
The CUHK-PWH Diabetes and Endocrine Centre was established in 1985 as a service and teaching unit at PWH, the teaching hospital of CUHK. Since then, it has expanded to include six functional units operated by over 100 staff members engaged in a series of interlinked research, care and education activities. Our strategy is to use evidence to change practice and influence policy. By joining the IDFCE Network, we hope to share our experiences and learn from other Centres in pursuit of our vision to prevent and control diabetes through innovation, teamwork and development of human resources.

By joining the IDFCE Network, we hope to share our experiences and learn from other Centres

2. What was the process to becoming an officially recognised Centre of Education?
We had to submit a detailed proposal articulating the vision, mission, activities, accomplishments and governance of our centre. We also had to include a strategy and plan of actions to achieve our goals. We were then visited by senior executives from IDF for two days when team leaders presented the structure, function and deliverables of each of the six units. They visited the different units and went through documents such as course materials, students’ feedback, meeting minutes, standards of operations, research plans and publications. They also observed the way how we used trained nurses and health care assistants to implement a structured care programme starting with a risk stratification programme to establish an on-going diabetes registry using standard protocols followed by empowerment and triage of patients into different care models. They were particularly interested in learning how this programme has evolved to become an internet-based disease management programme, the Joint Asia Diabetes Evaluation (JADE) programme. JADE is now being implemented in Asia to enable doctors to establish a diabetes registry for quality assurance and improvement purpose. They also interviewed two graduates of our Masters course, a pharmacist and a family doctor, to learn how the course has helped their professional development and patient management. They ended the visit by interviewing the programme directors and gave us their feedback and impression about the strategy and operation of the centre.

The endorsement by an independent and prestigious organisation such as IDF has enhanced our efforts to set up dialogues with relevant stakeholders

3. What has becoming a Centre of Education brought to your institution? And what are the benefits of being part of this network so far?
After the formal announcement in the Dubai meeting, we had our first meeting with leaders from the other 7 IDFCE in South America, Europe, Asia and Australia. All of us were impressed about the remarkable similarities in terms of challenges that we face and strategies that we develop to improve diabetes care through professional, patient and public education. The endorsement by an independent and prestigious organisation such as IDF has enhanced our efforts to set up dialogues with relevant stakeholders to extend our multipronged strategies to other sectors through collaborations and networking both within and outside Hong Kong.

4. What are your objectives as a newly selected Centre of Education for the coming year?
Our Government is now fully committed to developing career paths for diabetes nurses, including the appointment of Nurse Consultants, and providing extensive support to the primary care team including NGOs to use similar strategies such as risk stratification, structured care and peer support. This will undoubtedly improve quality of diabetes care in the community. In the coming year, our Centre will focus on three areas of unmet needs.

In the coming year, our Centre will focus on three areas of unmet needs.

Firstly, we are developing an outreach, detection and motivational programme targeted at middle-aged subjects. These individuals, if affected, are at very high risk of developing complications due to long disease duration, and yet often neglect their risk profiles due to competing priorities. Secondly, we will use an all-encompassing approach including change of clinic setting to enable the care team to use empowerment, peer support, personalized therapy and group dynamics to manage some difficult-to-treat patients, such as those with multiple comorbidities, obesity and early-onset disease. These patients often have multiple medical and psychological needs which cannot be dealt with adequately in busy clinic settings with 5-10 minute consultations. Thirdly, we will continue to engage key opinion leaders in Asia to champion the JADE programme to systematically evaluate the concept of using a doctor-nurse-clerk team to stratify risk and implement structured care, augmented by an electronic portal with risk engine, care protocols and decision support.

Our Government is now fully committed to developing career paths for diabetes nurses, including the appointment of Nurse Consultants, and providing extensive support to the primary care team including NGOs

5. How would you like to see the network developing in the future?
In response to the IDF Call to Action on Diabetes, we look forward to working closely with other members of the Network to develop collaborative projects with an ultimate objective of strengthening the health care system to ensure that people with diabetes have access to education, essential care and medications to prevent the onset and progression of complications. To this end, securing a career path for diabetes nurses who provide the liaison between patient and doctors is absolutely essential. By joining forces to collect the facts and figures regarding the cost-effectiveness of using a registry for quality assurance and a doctor-nurse team to deliver holistic and structured care, we hope these practices will become as standard as that of establishing a disease registry in the field of communicable disease and having a midwife in the field of obstetrics.

Prepared by Professor Juliana CN Chan and Dr. CC Chow, Co-directors of CUHK-PWH IDF Centre of Education