Evaluating the impact of an enhanced primary care diabetes service on diabetes outcomes: A before–after study. Issue 2 (April 2017)

• Record Type: Journal Article
• Authors: Seidu, S.; Bodicoat, D.H.; Davies, M.J.; Daly, H.; Stribling, B.; Farooqi, A.; Brady, E.M.; Khunti, K.
• Is Part Of: Primary care diabetes. Volume 11:Issue 2(2017)
• Page Start: 171
• Page End: 177
• Publication Date: 2017-04
• Subjects: Diabetes -- Models of care -- Non-elective bed days -- Primary Care -- Health care professional; Diabetes -- Periodicals; 616.462
• DOI: 10.1016/j.pcd.2016.09.005
• Languages: English
• ISSNs: 1751-9918

Abstract

Highlights: Diabetes is a primary care-sensitive or ambulatory care-sensitive condition. Integrated care models of primary-secondary teams can compromise continuity of care. We evaluated the use of diabetes service redesign involving skilled primary care teams. This model is unlikely to lead to an increase in complications and hospitalisations. The new enhanced model is as effective as the existing integrated care models. Abstract: Diabetes is an ambulatory care-sensitive condition and a high quality primary care or risk factor control can lead to a decrease in the risk of non-elective hospitalisations while ensuring continuity of care with usual primary care teams. Aims and methods: In this before and after study, eight primary care practices providing a newer enhanced diabetes model of care in Leicester UK, were compared with matched neighbouring practices with comparable demographic features providing a more expensive integrated specialist—community care diabetes service. The primary outcome at twelve months was to demonstrate equivalence in non-elective bed days. The enhanced practices had primary care physicians and nurses with an interest in diabetes who attended monthly diabetes education meetings and provided care plans and audits. The control practices provided an integrated primary-specialist care service. Results: The difference between the mean change in the non-elective bed days from baseline and at follow up in core and enhanced practices was not statistically significant (mean = 2.20 per 100 patients, 95% CI = −0.92 to 5.31 per 100 patients, p = 0.14). The analogous change for first outpatients' attendance were 0.23 per 100 patients (95% CI = −0.47 to 0.52 per 100 patients p = 0.92) and for diabetes related complications admissions was 0.30 per 100 patients (95% CI = −0.85 to 1.45 per 100 patients p = 0.55). Conclusion: A model of enhanced primary care based diabetes care appears unlikely to increase hospitalisations, outpatients' attendance or admissions for diabetes related complications.