Primary Care Diabetes Society

The term value‐based healthcare (VBHC) describes an approach to the organization and delivery of care that emphasizes reducing the cost of care while improving outcomes. This involves increased investment earlier in the care pathway e.g., in the prevention, timely diagnosis, and screening for complications in order to maximize the overall impact of care. Key elements of VBHC include the collection and interpretation of relevant data to drive quality improvement and appropriateness of care, a focus on a continuum of care from prevention through to complications, an awareness of the financial drivers of the cost of care and a recognition that meaningful outcomes of care are those that are important to patients. Although VBHC has its origins in North America and has mostly been applied to private health systems, the principles can also be applied to national health services. In publicly funded health systems, where resources are finite, VBHC initiatives aim to eliminate ineffective care that has no beneficial impact or added value for patients and to optimize patient outcomes by delivering care that meets the changing healthcare needs of a population over time. The National Health Service in Wales has established a VBHC Office and has begun to realize the benefits of adopting VBHC approaches. The Irish Health Service Executive (HSE) can learn from the approaches used in Wales. In this paper we explore some of the principles of VBHC through case studies from Ireland and Wales highlighting how national health services are using VBHC to achieve improvement in outcomes for people living with diabetes.

Best practice in injection technique is critical to ensuring optimal glycaemic control and is a part of good diabetes management. This article discusses the consequences of poor injection technique and offers advice on best practice in injection technique. A number of factors contribute to good technique, including injection site selection, injection site care, injection process, needle length, use of lifted skin folds (if appropriate) and rotation of injection sites. Health professionals also have a duty to teach and check an individual's injection technique, as well as to revisit and review their technique at subsequent consultations. All health professionals—especially nurses as the nursing role continues to expand—have a responsibility to acquire knowledge and skills in current best practice in injection technique. In doing so, they become better equipped to support patients effectively and safely, improve patients' quality of life and minimize the risk of complications associated with diabetes.