Abstract
BackgroundA new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting. This study evaluates the health and clinical benefits of the new model of care, assesses the acceptability of the model to patients, GPs and other health professionals, and examines the cost-effectiveness of the model.Methods/DesignThe study is an open, non-inferiority randomised controlled trial with data collected at baseline, 6 and 12 months. Participants are identified from new patients on hospital-based diabetes outpatient clinic waiting lists and new GP referrals. Eligible consenting patients are randomised to either a community practice site (intervention) or a hospital site (usual care). In the intervention model, medical care is led by a GP Clinical Fellow in partnership with an Endocrinologist. Quantitative measures include clinical indicators with HbA1c as the primary outcome; patient-reported outcomes include health-related quality of life, mental health and satisfaction with care. Qualitative methods will be used to explore the perspectives and experiences of patients and providers regarding the new model of care. An economic evaluation will also be undertaken.DiscussionThis model of care seeks to improve the quality and safety of healthcare at the interface between the hospital and primary care sectors for patients with complex diabetes. The study will provide empirical evidence about the impact of the model of care on health outcomes, patient and clinician satisfaction, as well as any economic impacts.Trial registrationClinical Trials Registry Number: ACTRN12612000380897
Highlights
A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting
The United Kingdom has introduced diabetes clinics conducted by general practitioners with special interests (GPwSIs) with demonstrated favourable improvements in HbA1c, cholesterol and blood pressure [13]
We present a protocol for the study design and methods to evaluate a new model of diabetes care in the community through multidisciplinary collaboration and integration across the primary-secondary interface
Summary
A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting. Follow-up and information technology systems, delivery of complex diabetes care in general practice can be as effective as hospital-based outpatient care [12]. The United Kingdom has introduced diabetes clinics conducted by general practitioners with special interests (GPwSIs) with demonstrated favourable improvements in HbA1c, cholesterol and blood pressure [13]. An evaluation of a diabetes management program based on integrated care and management between GPs and GPwSIs undertaken in Germany showed a reduction in HbA1c from baseline [18]. Similar studies in Belgium and the USA have demonstrated improved outcomes (HbA1c, systolic blood pressure and LDL-cholesterol) for diabetes patients using shared or integrated care between GPs and specialists [19,20,21]. A multidisciplinary and coordinated approach to diabetes care including collaboration between practitioners can result in effective, efficient service delivery [17,22]
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