Hunter and New England Diabetes Alliance: innovative and integrated diabetes care delivery in general practice
Shamasunder Acharya A B F , Annalise N. Philcox C , Martha Parsons A , Belinda Suthers D , Judy Luu A B , Margaret Lynch E , Mark Jones D and John Attia A DA Hunter New England Health District, John Hunter Hospital, Lookout Road, New Lambton Heights, NSW 2305, Australia.
B School of Medicine and Public Health, University of Newcastle, University Drive, Callaghan, NSW 2308, Australia.
C Department of Medicine, Calvary Mater Hospital, Edith Street, Waratah, NSW 2298, Australia.
D Clinical Research Design and Statistical Support Unit, Hunter Medical Research Institution, Lot 1, Kookaburra Circuit, New Lambton Heights, NSW 2305, Australia.
E Smith Street Medical Centre, 28 Smith Street, Charlestown, NSW 2290, Australia.
F Corresponding author. Email: shamasunder.acharya@health.nsw.gov.au
Australian Journal of Primary Health 25(3) 219-243 https://doi.org/10.1071/PY18179
Submitted: 22 November 2018 Accepted: 22 March 2019 Published: 21 June 2019
Abstract
Evidence-based standardised diabetes care is difficult to achieve in the community due to resource limitations, and lack of equitable access to specialist care leads to poor clinical outcomes. This study reports a quality improvement program in diabetes health care across a large health district challenged with significant rural and remote geography and limited specialist workforce. An integrated diabetes care model was implemented, linking specialist teams with primary care teams through capacity enhancing case-conferencing in general practice supported by comprehensive performance feedback with regular educational sessions. Initially, 20 practices were recruited and 456 patients were seen over 14 months, with significant improvements in clinical parameters. To date 80 practices, 307 general practitioners, 100 practice nurses and 1400 patients have participated in the Diabetes Alliance program and the program envisages enrolling 40 new practices per year, with a view to engage all 314 practices in the health district over time. Diabetes care in general practice appears suboptimal with significant variation in process measures. An integrated care model where specialist teams are engaged collaboratively with primary care teams in providing education, capacity enhancing case-conferences and performance monitoring may achieve improved health outcomes for people with diabetes.
Additional keywords: delivery of health care, diabetes mellitus type 2.
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