A patient-centred clinical approach to diabetes care assists long-term reduction in HbA1c

Abstract

INTRODUCTION: Patient-centred care has proven to be cost-effective, with a positive impact on health outcomes. A patient-centred approach is recognised as a desirable component of diabetes care. AIM: The aim of this audit was to determine if the specific patient-centred intervention offered by a clinical service (GPSI Diabetes service) improves diabetes care, as measured by changes in glycosylated haemoglobin (HbA1c). METHODS: The GPSI Diabetes service is a community-based service, run by a general practitioner with a specific interest (GPSI) in diabetes, and a practice nurse. Adults with diabetes are referred to the service by their general practitioner (GP) and care is provided using a set of loosely structured diabetes-specific patient-centred approaches. Following a series of visits, patients are discharged back to their GP. Baseline HbA1c was recorded at intake and for two years after discharge from the service. Patient and GP satisfaction questionnaires were also completed. RESULTS: New Zealand (NZ) Europeans and Maori with Type 2 diabetes and Type 1 diabetes experienced immediate and sustained (two-year) improvements in HbA1c. At intake, baseline HbA1c for Maori was higher than that of NZ Europeans. However, following this patient-centred intervention, this difference was reduced. None of the returned GP or patient questionnaires contained negative feedback, although the patient response rate was low. DISCUSSION: A patient-centred clinical approach to diabetes can contribute to significant and sustained reductions in HbA1c. This clinical approach is potentially reproducible in other clinical settings and could also be applied to the management of other chronic conditions. KEYWORDS: Chronic disease; clinical audit; diabetes mellitus; patient-centered care; self-management