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Denmark plans shake-up of diabetes care

Denmark

A clinic owned by the pharma company Novo Nordisk for 82 years passed into public ownership at the start of 2017. Now the Steno Diabetes Centre in Copenhagen is the focal point of a move to transform diabetes care across the region and beyond

The growing burden of diabetes on the health system and the economy are forcing a radical rethink of how services are delivered, according to Allan Flyvbjerg, CEO of the Steno Diabetes Centre in Copenhagen, one of the oldest specialist diabetes clinics in the world, which has now put itself at the forefront of transforming care for the future.

As a physician and a researcher who spent more than a decade at the helm of the Danish Diabetes Association, Flyvbjerg has seen the diabetes epidemic mushroom in recent years. He intends to take direct action to stem the tide as head of one of the best-funded diabetes clinics in the world.

“We have the ambition to offer world class treatment, research, education and prevention for the benefit of the population with, or at risk of, diabetes,” Flyvbjerg told Healthy Measures.

The Steno’s potential to deliver on this vision is a result of its unique history and funding structure. From its founding in 1932 to its transfer to the Capital Region of Denmark at the start of 2017, the clinic was owned by the pharma company Novo Nordisk, one the world’s leading manufacturers of diabetes drugs.

The company’s charitable trust, Novo Nordisk Foundation donated €400 million for the period 2017-2029 towards the running of Steno. With the public financing the clinic will receive for routine management of diabetes cases, the total budget for the next 12 years is a sizeable €600 million.

“Our funding model gives us a once in a lifetime opportunity,” says Flyvbjerg. Steno will have the capacity to develop new evidence on what works best for people with diabetes, as well as supporting educational programmes designed to reduce the long-term burden of disease.

“A lot of public funding is activity-based – clinics are usually funded to follow guidelines and deploy standard treatments,” says Flyvbjerg. “The donation we have allows us to develop and implement new evidence in the clinic.”

This means turning the knowledge generated in labs into new tools and treatments in the real world, something for which Flyvbjerg says it can be difficult to find funding.

Patient-centred architecture

The clinic will soon have a new home in a state-of-the-art hospital due for completion in 2020. It has been designed to ensure people move through the physical building with the greatest ease.

“Time in the diabetes centre should be time well spent for citizens,” says Flyvbjerg. Multidisciplinary teams of experts will be on hand to work with patients to achieve their health goals and, if service users must wait for appointments, they should be able to work on their computers or spend time learning about their condition.

Steno will collaborate with the other hospitals and GPs in the region. Service users will have access to dieticians, physical therapists, screening and treatment for foot complications, eye conditions, nephrology, neurology, cardiovascular and dental specialists. They will also work to improve the management of people with diabetes and other comorbidities.

“Close collaboration between the multidisciplinary team and general practitioners is becoming even more important as hospital doctors become increasingly specialised,” said Tina Vilsbøll, head of the clinic. “It’s vital to have world-class diabetes specialists working closely together with specialists within general endocrinology, nephrology, cardiology and so on, but we need to keep GPs in the loop as they have a long-term relationship with the patient.”


The clinic will also put great emphasis on measuring patient experiences and patient outcomes. Constant measurement is an essential element of the value-based healthcare philosophy that some experts believe can deliver better results while containing costs – helping to ensure that health systems are sustainable in the face of a mounting diabetes epidemic.

“We need to gather knowledge and, ideally further scientific evidence, on how best to work together – this means recording more than just blood glucose or blood pressure,” Vilsbøll said. “We must look at patient-reported outcomes and quality of life measures.”

Denmark has a tradition of recording patient data in a national database and now requires GPs to report patient outcomes for diabetes patients, something Vilsbøll sees as a chance for supporting and educating GPs. “Ideally, all the data on all of GPs’ diabetes patients would automatically go into the database so that we can help GPs with their most difficult cases.”

Scaling up

Steno’s riches have raised eyebrows among some diabetes experts who question whether other regions of Denmark will be left behind. Flyvbjerg argues that advances at the clinic will benefit people in other regions of Denmark too and may, eventually, spread around the world.

The ambition for the new centre is to raise the bar for the entire diabetes field in the Capital Region of Denmark and to contribute new knowledge at national and international levels. This will be through offering the best treatment and prevention for everyone in the region with diabetes.

“Everyone in the region with diabetes should be offered the same high-quality treatment, irrespective of whether they are being monitored by a diabetes department, a health centre or their GP,” Flyvberg said.

“We’ll be setting up partnerships with other hospitals, general practice, municipalities, universities and other educational institutions in the regions, whereby we can collaborate on increasing focus on diabetes and improve treatment”.

Beyond Copenhagen, there are plans to expand the Steno model to the other four regions in Denmark, where new models of diabetes care could be tested and deployed. In addition, experts from Europe and beyond have visited the centre to learn about its approach.

As Flyvbjerg opens a new chapter in diabetes care, he promises to share Steno’s experience so that others can implement evidence-based care: “We will measure outcomes of everything we do so it can be scaled up elsewhere,” he said.

 

 

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