Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial

Russell, A. W., Baxter, K. A., Askew, D. A., Tsai, J., Ware, R. S. and Jackson, C. L. (2013) Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabetic Medicine, 30 9: 1112-1121. doi:10.1111/dme.12251


Author Russell, A. W.
Baxter, K. A.
Askew, D. A.
Tsai, J.
Ware, R. S.
Jackson, C. L.
Title Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial
Journal name Diabetic Medicine   Check publisher's open access policy
ISSN 0742-3071
1464-5491
Publication date 2013
Year available 2013
Sub-type Article (original research)
DOI 10.1111/dme.12251
Open Access Status
Volume 30
Issue 9
Start page 1112
End page 1121
Total pages 10
Place of publication Chichester, West Sussex, United Kingdom
Publisher Wiley-Blackwell
Collection year 2014
Language eng
Formatted abstract
Aims: To evaluate patient outcomes for a novel integrated primary/specialist model of community care for complex Type 2 diabetes mellitus management compared with outcomes for usual care at a tertiary hospital for diabetes outpatients.

Methods: This was a prospective open controlled trial performed in a primary and tertiary care setting in Australia. A total of 330 patients with Type 2 diabetes aged >18 years were allocated to an intervention (n=185) or usual care group (n=145). The intervention arm was a community-based model of care led by a general practitioner with advanced skills and an endocrinologist partnership. Usual care was provided via the hospital diabetes outpatient department. The primary end point was HbA1c concentration at 12 months. Secondary end points included serum lipids and blood pressure.

Results: The mean change in HbA1c concentration in the intervention group was -9 mmol/mol (-0.8%) at 12 months and in the usual care group it was -2 mmol/mol (-0.2%) (95% CI -5,1). The percentage of patients in the intervention group achieving the HbA1c target of ≤53 mmol/mol (7%) increased from 21 to 42% (P<0.001); for the usual care group there was a 1% increase to 39% of patients attaining this target (P=0.99). Patients in the intervention group experienced significant improvements in blood pressure and total cholesterol compared with those in the usual care group. The percentage of patients achieving clinical targets was greater in the intervention group for the combined target of HbA1c concentration, blood pressure and LDL cholesterol.

Conclusions: A community-based, integrated model of complex diabetes care, delivered by general practitioners with advanced skills, produced clinical and process benefits compared with a tertiary diabetes outpatient clinic.
Keyword Chronic disease management
General-practice
Consensus algorithm
Glucose control
Hyperglycemia
Intervention
Metaanalysis
Adjustment
Regression
Initiation
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Published online: 28 June 2013.

 
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Created: Fri, 26 Jul 2013, 11:11:43 EST by Shani Lamb on behalf of Discipline of General Practice