3DFD is set in South London, UK, in the inner-city boroughs of Lambeth and Southwark, areas with high levels of deprivation and ethnic diversity with a combined resident population of 600,000 .The prevalence of type 2 diabetes is 4% ( 24,000 people).
The service consists of a liaison psychiatrist and 2 community workers from ThamesReach, a local third sector social welfare organization originally designed for supporting homeless people.
The care pathway is embedded into routine diabetes in the community or hospital diabetes services, depending on where the patient prefers to receive care.
- GPs refer directly or via the community teams for intensive diabetes management after completing a simple referral form allowing identification of psychological and/or social problems and poor glycaemic control
- Following triage, the interventions include:
- brief focused psychological treatments such as cognitive behavior therapy, counselling, and motivational interviewing
- optimizing psychotropic medication
- interventions targeting social problems, such as poor housing, debt management, literacy, carer support, domestic violence and childcare, occupational rehabilitation
- patient-led case conferences to integrate psycho-social care with diabetes care by addressing barriers to diabetes self-care, risk assessments and patient safety
- Once the patient has made progress, 3DFD supports the return of the patient to routine diabetes care