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G579(P) School clinics: improving the independence of young people with diabetes

Aim One of the biggest challenges in paediatrics is helping young people with chronic conditions develop increasing independence as they grow up. An important barrier to this is reliance on parents to accompany young people to hospital appointments. We aimed to facilitate young people’s independence and prepare them for transition to adult services by running a pilot nurse-led clinic at a school. Methods We selected a secondary school where our team was responsible for multiple patients with type 1 diabetes. We scheduled onsite clinics throughout the year where young people could see a diabetes clinical nurse specialist either alone or with a friend in attendance. This replaced two of their four annual appointments. The school nurse was present for clinicians to highlight issues to the school. Following the school clinic, young people filled out a four-question survey. A junior doctor interviewed clinical staff for further qualitative feedback. Results All young people seen during the first clinic agreed that they felt more able to discuss sensitive issues and more confident to see a nurse or doctor on their own. They agreed that other students in their school understood their diabetes better. One student provided the following written feedback ‘I liked today’s appointment because it was more free since my mum wasn’t here’. Nurses running the clinic found it easier to discuss issues such as drugs, alcohol and sexual health without parents present. They reported young people engaged better with decisions surrounding diabetes management. Issues identified included difficulties scheduling around the school day and physical space available. The school clinic will run for the duration of 2018–2019 with further results expected. Conclusions Our experience supports school clinics as a tool for improving patient experience in children with type 1 diabetes. School clinics address several issues with the current model of care. They minimise time spent away from education, facilitate discussion of topics young people may not disclose around their parents and permit greater peer and school involvement. Importantly, they build young people’s confidence to see health professionals alone, which prepares them for adult services.