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Eksperci o koniecznych zmianach w standardzie opieki nad chorymi z cukrzycą

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Standard opieki zdrowotnej dla chorych na cukrzycę i kompleksowa porada diabetologiczna – to zmiany, jakie zaproponowali eksperci podczas debaty na posiedzeniu Parlamentarnego Zespołu ds. Praw Pacjentów. Rozwiązania mogą przyczynić się do opóźnienia powikłań cukrzycy, w tym również zespołu stopy cukrzycowej.

Podczas debaty, która odbyła się 24 sierpnia br. eksperci przedstawili swoje rekomendacje w raporcie Fundacji Eksperci dla Zdrowia pt. „Ścieżka opieki nad chorym na cukrzycę. Kluczowe aspekty i rekomendacje zmian”.

– Standard opieki i kompleksowa porada diabetologiczna zostały wypracowane po to, żeby spełnić nadrzędne cele, a mianowicie zmniejszyć ryzyko rozwoju i progresji przewlekłych powikłań i wydłużyć życie naszych pacjentów z cukrzycą, których jest coraz więcej – podkreślała prof. Dorota Zozulińska-Ziółkiewicz, prezes Polskiego Towarzystwa Diabetologicznego, współautorka raportu.

Rosną koszty leczenia cukrzycy i jej powikłań

Marzena Domańska-Sadynica, prezes Fundacji Eksperci dla Zdrowia, powołała się na raport NIK z 2018 r. dotyczący leczenia i profilaktyki cukrzycy typu 2. Z dokumentu wynika, że sytuacja diabetyków w Polsce jest bardzo niekorzystna. Pandemia, jak zauważa ekspertka, jeszcze bardziej ją pogorszyła. Ponadto zaobserwowano wzrost całkowitych kosztów leczenia cukrzycy i jej powikłań.

Zdaniem Domańskiej-Sadynicy raport NIK pokazuje, że zadania systemu ochrony zdrowia związane z zapobieganiem, wczesnym wykrywaniem i leczeniem cukrzycy typu 2. nie były w Polsce skuteczne. Wskazuje, że „u żadnego pacjenta w przypadku udzielania świadczeń w podstawowej opiece zdrowotnej i ambulatoryjnej opiece specjalistycznej nie uzyskano pełnego wyrównania metabolicznego.” Ekspertka zaznacza, że lekarze nie wywiązywali się ze swoich obowiązków  – nie kierowali pacjentów na wymagane w ciągu roku badania diagnostyczne i konsultacje specjalistyczne. Według prezes fundacji, w Polsce pacjenci z cukrzycą typu 2. nie są pod dobrą opieką, błąkają się w systemie i nie mają zapewnionych specjalistycznych porad.

Prof. Leszek Czupryniak, ordynator Oddziału Klinicznego Diabetologii i Chorób Wewnętrznych Uniwersyteckiego Centrum Klinicznego WUM, który jest współautorem raportu Fundacji Eksperci dla Zdrowia, przypomniał, że w marcu 2018 r. powstał standard opieki nad chorymi na cukrzycę powołany zarządzeniem ministra zdrowia. Ekspert zaznaczył jednak, że projektowany standard nie został do tej pory wprowadzony.

Co powinno należeć do obowiązków POZ w opiece nad cukrzykami?

Prof. Czupryniak podkreślał, że podstawowe zadania, jakie wypełniać powinny placówki POZ, to m.in. promocja zdrowia, identyfikacja czynników ryzyka cukrzycy, profilaktyka i diagnostyka zaburzeń gospodarki węglowodanowej czy edukacja w zakresie stanów przedcukrzycowych i cukrzycy typu 2. Ekspert zaznaczył również, że POZ powinny kierować pacjentów do poradni diabetologicznej w szczególnych przypadkach, m.in. – cukrzycy typu 1., cukrzycy u dzieci i młodzieży, kobiet planujących ciążę i ciężarnych. Ponadto pacjenci powinni trafić do poradni specjalistycznej, gdy cele terapeutyczne nie są osiągane i w celu intensyfikacji leczenia insuliną, a także gdy występują choroby współistniejące i powikłania.

Lekarze POZ, w opinii prof. Czupryniaka, powinni również monitorować stan pacjentów z cukrzycą i wykonywać badania pomiaru masy ciała, ciśnienia, a także zlecać badania biochemiczne oraz poziomu cholesterolu, badanie moczu oraz w kierunku niewydolności nerek. Ponadto jego zdaniem cukrzycy nie powinni być leczeni wyłącznie przez diabetologów. W ramach standardu chorzy mogą być również kierowani na inne konsultacje specjalistyczne, takie jak kardiologiczne, neurologiczne czy w kierunku powikłań ze strony nerek.

W kwestii opieki ambulatoryjnej z kolei, zdaniem prof. Czupryniaka, powinna zajść istotna zmiana, a mianowicie opieka dwupoziomowa, która odbywałaby się na poziomie podstawowych poradni diabetologicznych oraz referencyjnych poradni diabetologicznych. Zdaniem eksperta w każdym województwie powinna funkcjonować przynajmniej jedna poradnia referencyjna.

Kompleksowa porada diabetologiczna

Kolejną zmianą proponowaną przez ekspertów jest kompleksowa porada diabetologiczna. Rozwiązanie byłoby odrębnie finansowanym świadczeniem. Prof. Czupryniak wskazuje, że celem tej zmiany jest wcześniejsze wpływanie na powikłania rozwijające się w cukrzycy.

– Chcielibyśmy doprowadzić do sytuacji, że pacjenci są regularnie w ramach POZ kierowani na wizyty kontrolne do diabetologa – żeby chory z cukrzycą był raz w roku obejrzany przez diabetologa z ustaleniem szczegółowego planu leczenia – tłumaczył ekspert.

Jak zauważył prof. Czupryniak powikłania cukrzycy często zaczynają się bezobjawowo. Dlatego tak ważne jest, by wcześniej wychwycić ewentualne problemy.

Źródło: PAP

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