The following values guide the decisions and actions of the DCPNS.  We believe in:

• Excellence

• Collaboration

• Responsiveness

• Evidence

• Inclusiveness

• Accountability

• Integrity

• Advises the Department of Health on service delivery models.
• Establishes, promotes, and monitors adherence to diabetes care guidelines.
• Provides support, services, and resources to diabetes healthcare providers.
• Collects, analyzes, and distributes diabetes-related data for Nova Scotia.

The Program is currently involved in/or supporting research that includes:

• Exploration and validation of case definitions for the National Diabetes Surveillance System.
• Pilot testing the development of a Diabetes Data Repository for Nova Scotia.
• Evaluating the province’s Diabetes Assistance Program as established in 2006.
• Implementing the DCPNS Physical Activity & Exercise Tool-Kit in Nova Scotia Diabetes Centres.
• Partnering with others to gain a better understanding of the barriers to blood pressure management
  in persons with diabetes, the role of self-blood glucose monitoring in diabetes management, and prediabetes lifestyle programming.

The DCPNS provides:

• Diabetes expertise including program planning and evaluation.
• Standardized documentation, statistics keeping, and referral forms.
• Guidelines for special populations (e.g., pregnancy; pediatrics) and specific complications/co morbidities (e.g., hypertension, dyslipidemia, renal impairment, foot problems).
• Access to new knowledge and knowledge translation through quarterly newsletters and annotated bibliographies, annual provincial and/or regional workshops and facility or district diabetes surveys.
• Enhanced networking across and between programs.
• The DCPNS Registry with access to local and regional data as well as data analysis support and reporting.
• Provincial policy and procedures (including exams) for insulin dose adjustment and DC grants for quality improvement initiatives.

DCPNS is supported by an Advisory Council, several working groups and committees and ~seven full-time equivalent staff positions.
 

Diabetes Centres in Nova Scotia

DCs provide programs and services to people with diabetes and their family members. Depending on location, DCs may be referred to as Diabetes Education Centres, Diabetes Management Centres, Diabetic Clinics, or Diabetes Day Care Centres. There are currently 39 full and part-time DCs in Nova Scotia. All DCs in Nova Scotia are staffed with specialized nurse and dietitian teams (diabetes educators) and have a Medical Advisor appointed by their facility/DHA. These DC teams access other disciplines, as available, for individuals in need (social worker, psychologist/trained mental health therapist, pharmacist, foot care clinic/specialist, etc.) and promote linkage to valuable community service providers and programs. These DCs exemplify specialized care management at its best. The staff of DCs provide referring physicians with access to a complementary inter/multidisciplinary team. This team approach is essential in helping individuals with diabetes manage their disease. In Nova Scotia, the approach to care and education has been standardized with the assistance of the DCPNS.

The DCPNS ensures that these programs promote selfcare, survey for and monitor the development/progression of diabetes complications, and follow national and provincial guidelines for optimal care. The DCPNS supports all DCs with activities focused on knowledge transfer/translation, networking in support of best/promising practice, and standardization aimed at quality/equitable care. DCs in Nova Scotia offer programs and services to individuals diagnosed with diabetes and prediabetes as well as their family members. Services and programs include:

• Individual Assessment. Using a patient/family centred approach, DC staffs assist physicians in devising, monitoring, and revising individualized treatment plans. All programs use standardized documentation forms including a flow sheet to assess and guide care overtime.
• Individual and Group Education. Most DCs provide a core educational program followed by topic-specific educational modules. Self-management education focuses on the required knowledge, skills, and behaviours required to live well with diabetes. DCs address all metabolic abnormalities associated with diabetes—dysglycemia, hyperlipidemia, and hypertension. DCs also provide specialized counselling in the presence of progressive complications (nephropathy, gastroparesis, etc.).
• Motivational Counselling. DC staffs promote realistic goal setting and problem solving to assist with behavior change while short-and long-term follow-up provides much needed motivation.
  Initial and ongoing monitoring for diabetes complications
  development and progression.
• Promoting and Facilitating Adherence to Recommended Clinical Practice Guidelines. This includes the introduction and reinforcement of metabolic targets, routine testing, and annual assessments.
  Initiating insulin*. This service is provided following receipt of the physician order.
• Adjusting Insulin. This service is provided if the diabetes educators have been certified according to approved provincial DCPNS policy and guidelines as a delegated medical function.
• Foot Assessments. DC nurses conduct routine, annual foot assessments (more frequently as required), using a standardized approach/form.
• Prediabetes programming. This service component (individual and/or group) introduces the at-risk individual to diabetes (signs, symptoms, and risk factors) and reinforces the role of lifestyle modification in prevention.
• Linkage to Available Community Programs and Services (e.g., walking trails, grocery store tours, recreation programs, etc.). This natural extension of programming encourages sustainable behavior change.

DC staff are instrumental in influencing provider and patient practices. Enhanced communication and routine reporting to referring and specialist physicians provide added insight into the recommended treatment plan and suggested modifications according to recommended guidelines, to improve outcomes. In keeping with chronic disease management, the DCs’ focus on self-care and patient empowerment helps activate individuals living with diabetes to expect and request consistent, quality diabetes care.

Managing Diabetes Data for Nova Scotia

The DCPNS manages the province’s diabetes databases including the National Diabetes Surveillance System Nova Scotia dataset as well as the DCPNS Registry. The Registry is inclusive of new referrals to Nova Scotia’s 38 Diabetes Centres (DCs) since April 1, 1994 (one of the 39 diabetes programs, Eskasoni First Nation, does not provide data to the Registry). To March 31, 2009, the Registry contains over 73,000 individual cases (all ages and all types of diabetes and prediabetes). The DCPNS Registry allows for the collection of a number of data elements including type of diabetes/prediabetes, type of treatment, date of diagnosis, date of birth, and presence of medical problems (comorbidities), among others. For DCs that use the DCPNS Registry on-site (31 in total representing over 85% of all diabetes cases), additional data is collected related to clinical (blood pressure, glycated hemoglobin, creatinine, etc.)and self-care practices (frequency of self-monitoring of blood glucose, date of eye examination, etc.). These databases provide invaluable data to the province, District Health Authorities, and individual DCs. The data is used in support of provincial initiatives, for program planning at the District level, and to assess the merit of targeted interventions or quality improvement programs. DCs using the DCPNS Registry onsite benefit from population and individual level reports. Local data is used to target interventions in keeping with key quality indicators.