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Evaluating the impact of an enhanced primary care diabetes service on diabetes outcomes: A before-after study

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journal contribution
posted on 08.04.2020, 08:50 by S Seidu, DH Bodicoat, MJ Davies, H Daly, B Stribling, A Farooqi, EM Brady, K Khunti
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.

Funding

SS, EMB, HD, BS AF, DHB, MJD and KK acknowledge support from the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care—East Midlands (NIHR CLAHRC—EM), the Leicester Clinical Trials Unit and the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit, which is a partnership between University Hospitals of Leicester NHS Trust, Loughborough University and the University of Leicester. We also acknowledge Merck Sharp & Dohme Limited (“MSD”) for doing the data extraction as a third party.

History

Citation

Primary Care Diabetes Volume 11, Issue 2, April 2017, Pages 171-177

Version

AM (Accepted Manuscript)

Published in

PRIMARY CARE DIABETES

Volume

11

Issue

2

Pagination

171 - 177 (7)

Publisher

ELSEVIER SCI LTD

issn

1751-9918

eissn

1878-0210

Acceptance date

25/09/2016

Copyright date

2016

Available date

10/10/2016

Publisher version

https://www.sciencedirect.com/science/article/pii/S1751991816301012

Spatial coverage

England

Language

English