DIABETES TODAY 4/5: Denmark’s new model of diabetes care
‘We have to treat citizens not diseases,’ says Dr Allan Flyvbjerg, CEO of the Steno Diabetes Center Copenhagen (SDCC). ‘It’s time to take a different view of the people we serve and how we do it.’
Dr Flyvbjerg’s credentials as a diabetes expert are hard to beat. As a physician, a researcher and having spent more than a decade at the helm of the Danish Diabetes Association, he has seen the diabetes epidemic mushroom in recent years. Dr Flyvbjerg says the burden of diabetes on the population, the health system and the economy are forcing a radical rethink of how services are delivered.
The patient-centred model embraced by the SDCC prescribes an active role for patients and a dose of humility for physicians. ‘Think of every doctor-patient dialogue as a meeting between two specialists,’ he says. ‘One is a specialist in diabetes and the other is a specialist in their own life.’
The new SDCC will quite literally put patients at the heart of its work. A new building to be completed in 2020 aims to ensure people move through the physical building with the greatest ease. 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. ‘Time in the diabetes centre should be time well spent for citizens,’ says Dr Flyvbjerg.
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 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.
The new model embraced at the SDCC is a result of its unique history and funding structure. The clinic has treated people with diabetes since 1932 and was owned by Novo Nordisk A/S until the end of 2016 when it was transferred to the Capital Region of Denmark, a non-profit body.
Not only is the clinic now in public ownership but the Novo Nordisk Foundation made a donation of €0.4 billion (2.95 billion DKK) for the period 2017-2029. Added to the public financing the clinic will receive for routine management of diabetes cases, the total budget for the next 12 years is sizeable €0.6 billion.
The scope that that new public-private funding model gives the clinic is one of the reasons their director left a good job to play his part in reimagining diabetes services.
‘This gives us a once in a lifetime opportunity,’ says Dr Flyvbjerg. ‘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.’
The SDCC 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 – we are funded to follow guidelines and deploy standard treatments,’ says the SDCC chief. ‘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 treatment systems in the real world – something which Dr Flyvbjerg says can be difficult to find funding for.
The diabetes epidemic is global. Advances at the SDCC will benefit not only citizens in Copenhagen but in other regions of Denmark too – and may, eventually, spread around the world.
The centre will be able to manage up to 14,000 patients annually, but will in addition support an improvement of diabetes care for all 105,000 citizens with diabetes in the Capital Region. This ambition will be achieved through collaboration with the other hospitals in the region, municipalities and general practice. 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.
Beyond Copenhagen, there are presently plans of expanding the SDCC-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 their unique approach.
As Dr Flyvbjerg’s team being an exciting new chapter in diabetes care, they promise to share their experiences so that others can implement evidence-based care: ‘We will measure outcomes of everything we do so it can be scaled up elsewhere.’
ABOUT ALLAN FLYVBJERG
Allan Flyvbjerg graduated from Aarhus University, Denmark in 1986, defended his thesis (DMSc) in 1993, became a specialist in Endocrinology and Internal Medicine in 1999, Chief Physician in 2001, Professor in Experimental Medical Research in 2005, Chair in Endocrinology in 2009 and Dean of the Faculty of Health, Aarhus University in 2011. In 2016 he was appointed CEO of Steno Diabetes Center Copenhagen (SDCC) and Professor in Clinical Endocrinology at the University of Copenhagen, Denmark. Finally, Allan Flyvbjerg was President of the Danish Diabetes Association (which has approximately 80,000 members) from 2000–2011.