‘Working with the team’: an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care
Julie Hepworth A B F , Deborah Askew C , Claire Jackson C and Anthony Russell D EA Centre for Primary Health Care Research, School of Medicine, The University of Queensland, Herston, Qld 4006, Australia.
B School of Nursing and Midwifery, The University of Queensland, Level 2, Building 12, 11 Salisbury Road, Ipswich, Qld 4305, Australia.
C Discipline of General Practice, School of Medicine, The University of Queensland, Level 8, Health Sciences Building, Building 16/910, Royal Brisbane and Women’s Hospital, Herston, Qld 4029, Australia.
D School of Medicine, The University of Queensland, Princess Alexandra Hospital, Woolloongabba, Qld 4102, Australia.
E Department of Diabetes and Endocrinology, Princess Alexandra Hospital, Woolloongabba, Brisbane, Qld 4102, Australia.
F Corresponding author. Email: j.hepworth@uq.edu.au
Australian Journal of Primary Health 19(3) 207-212 https://doi.org/10.1071/PY12087
Submitted: 9 July 2012 Accepted: 24 July 2012 Published: 4 September 2012
Abstract
This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants’ responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.
Additional keywords: multiprofessional teamwork, patient-centred care, patient empowerment, patient engagement, primary health care.
References
Beverly EA, Hultgren BA, Brooks KM, Ritholz MD, Abrahamson MJ, Weinger K (2011) Understanding physicians challenges when treating type 2 diabetic patients’ social and emotional difficulties. A qualitative study. Diabetes Care 34, 1086–1088.| Understanding physicians challenges when treating type 2 diabetic patients’ social and emotional difficulties. A qualitative study.Crossref | GoogleScholarGoogle Scholar |
Britt H, Miller G, Charles J, Henderson J, Bayram C, Pan Y, Valenti L, Harrison C, O’Halloran J, Fahridin S (2010) General Practice Activity in Australia 2009–10. General Practice Series No. 27. Cat. no. GEP 27. Australian Institute of Health and Welfare, Canberra.
Cheraghi-Sohi S, Bower P, Mead N, McDonald R, Whalley D, Roland M (2006) What are the key attributes of primary care for patients? Building a conceptual ‘map’ of patient preferences. Health Expectations 9, 275–284.
| What are the key attributes of primary care for patients? Building a conceptual ‘map’ of patient preferences.Crossref | GoogleScholarGoogle Scholar |
Chin MH, Cook S, Drum ML, Jin L, Guillen M, Humikowski CA, Koppert J, Harrison JF, Lippold S, Schaefer CT (2004) Improving diabetes care in Midwest community health centers with the health disparities collaborative. Diabetes Care 27, 2–8.
| Improving diabetes care in Midwest community health centers with the health disparities collaborative.Crossref | GoogleScholarGoogle Scholar |
Department of Health and Ageing (2009a) National Health and Hospitals Reform Commission. A healthier future for all Australians: final report June 2009. Australian Government, Canberra.
Department of Health and Ageing (2009b) Building a 21st century primary health care system. A draft of Australia’s first national primary health care strategy. Australian Government, Canberra.
Flick U (2011) ‘Introducing Research Methodology’. (Sage Publications: London)
Flocke SA (1997) Measuring attributes of primary care. Development of a new instrument. The Journal of Family Practice 45, 64–74.
Flocke SA, Miller W, Crabtree BF (2002) Relationships between physician practice style, patient satisfaction, and attributes of primary care. The Journal of Family Practice 51, 835–840.
Guest G, Bunce L, Johnson L (2006) How many interviews are enough? An experiment with data saturation and variability. Field Methods 18, 59–82.
| How many interviews are enough? An experiment with data saturation and variability.Crossref | GoogleScholarGoogle Scholar |
Haggerty J, Burge F, Levesque J-F, Gass D, Pineault R, Beaulieu M-D, Santor D (2007) Operational definitions of attributes of primary health care: Consensus among Canadian experts. Annals of Family Medicine 5, 336–344.
| Operational definitions of attributes of primary health care: Consensus among Canadian experts.Crossref | GoogleScholarGoogle Scholar |
Holman RR, Paul SK, Bethel MA, Matthews DR, Neil HA (2008) 10-year follow-up of intensive glucose control in type 2 diabetes. The New England Journal of Medicine 359, 1577–1589.
| 10-year follow-up of intensive glucose control in type 2 diabetes.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD1cXht1Wgt7nK&md5=ebfdf1519829f257fd82b9b9897afa0eCAS |
Jackson C, Tsai J, Brown C, Askew DA, Russell A (2010) GPs with special interests impacting on complex diabetes care. Australian Family Physician 39, 972–974.
Jowsey T, Yen L, Wells R, Leeder S (2011) National Health and Hospital Reform Commission final report and patient-centred suggestions for reform. Australian Journal of Primary Health 17, 162–168.
| National Health and Hospital Reform Commission final report and patient-centred suggestions for reform.Crossref | GoogleScholarGoogle Scholar |
Patton MQ (2002) ‘Qualitative research and evaluation.’ 3rd edn. (Sage Publications: Thousand Oaks, CA)
Pope C, Ziebland S, Mays N (2000) Qualitative research in health care: analysing qualitative data. British Medical Journal 320, 114–116.
| Qualitative research in health care: analysing qualitative data.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3c%2FptVOgug%3D%3D&md5=206a39a1fe9eb08d13090a8dffa8c579CAS |
Renders CM, Valk GD, Griffin SJ, Wagner E, van Eijk JT, Assendelft WJJ (2001) Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings. Cochrane Database of Systematic Reviews CD001481
| Interventions to improve the management of diabetes mellitus in primary care, outpatient and community settings.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD38%2FgslOhtQ%3D%3D&md5=d95284882384e9fecbf5c72b8feeed0bCAS |
Stratton IM, Adler AI, Neil HA, Matthews DR, Manley SE, Cull CA, Hadden D, Turner RC, Holman RR (2000) Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study. BMJ (Clinical Research Ed.) 321, 405–412.
| Association of glycaemia with macrovascular and microvascular complications of type 2 diabetes (UKPDS 35): prospective observational study.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3cvisFWnsg%3D%3D&md5=5e09c091614ecc2ab00171a5a1ff4dabCAS |
Stratton IM, Cull CA, Adler AI, Matthews DR, Neil HA, Holman RR (2006) Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75). Diabetologia 49, 1761–1769.
| Additive effects of glycaemia and blood pressure exposure on risk of complications in type 2 diabetes: a prospective observational study (UKPDS 75).Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD28vgslyhsg%3D%3D&md5=86460a6603a984a655a3fc0b3da0cd16CAS |
Wild S, Roglic G, Green A, Sicree R, King H (2004) Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care 27, 1047–1053.
| Global prevalence of diabetes: estimates for the year 2000 and projections for 2030.Crossref | GoogleScholarGoogle Scholar |
