Abstract
BackgroundAs diabetes prevalence rises world-wide, the arrangement of clinics and care packages is increasingly debated by health care professionals (HCPs), health service researchers, patient groups and policy makers. ‘Integrated care’, while representing a range of approaches, has been positioned as a promising solution with potential to benefit patients and health systems. This is particularly the case in rural populations which are often removed from centres of specialist care. The social arrangements within diabetes integrated care initiatives are understudied but are of particular importance to those implementing such initiatives. In this paper we explore the ‘work’ of integration through an analysis of the role played by Health Care Assistants (HCAs) who were specially trained in aspects of diabetes care and given the title ‘Diabetes Care Technician’ (DCT).MethodsUsing thematic analysis of interview (n = 55) and observation data (n = 40), we look at: how the role of DCTs was understood by patients and other HCPs, as well as the DCTs; and explore what DCTs did within the integrated care initiative.ResultsOur findings suggested that the DCTs saw their role as part of a hierarchy, providing links between members of the integrated team, and explaining and validating clinical decisions. Patients characterised DCTs as friends and advisors who provided continuity. Other HCPs perceived the DCTs as supportive, providing long-term monitoring and doing a different job to conventional HCAs. We found that DCTs had to navigate local terrain (social, ethical and physical), engage in significant conversation and negotiate treatment plans created through integrated care. The analysis suggests that relationships between patients and the DCTs were strong, had the quality of friendship and mitigated loneliness.ConclusionsDCTs played multidimensional roles in the integrated care initiative that required great social and emotional skill. Building friendships with patients was central to their work, which mitigated loneliness and facilitated the care they provided.
Highlights
As diabetes prevalence rises world-wide, the arrangement of clinics and care packages is increasingly debated by health care professionals (HCPs), health service researchers, patient groups and policy makers
The initiative included: (a) organisational redesign, which established a network of local diabetes professionals; (b) providing specialist support for primary care providers through the allocation of a consultant, diabetes specialist nurse (DSN), diabetes specialist dietician and diabetes specialist podiatrist to each practice, as well as the provision of ‘virtual’ clinics in which advice on individual patients was given to primary care providers through the collective review of medical records and discussion; (c) increased patient, primary care and community education; and (d) increased care closer to home, including in multidisciplinary community-based clinics, increased access to diabetes specialist nursing, dietetic and podiatry clinics and increased home visiting by Diabetes Care Technician’ (DCT)
How is the role of the DCT understood? we present an analysis of how DTCs, patients and other HCPs perceived the role and work of the DCTs
Summary
As diabetes prevalence rises world-wide, the arrangement of clinics and care packages is increasingly debated by health care professionals (HCPs), health service researchers, patient groups and policy makers. In the UK, recent figures suggest that the population-adjusted prevalence of diabetes will grow from 6.6 to 7.4% between 2013 and 2035 [3] This predicted growth in prevalence will increase costs to the healthcare system [4], and has potential to bring significant suffering to the lives of affected individuals, families and communities. As well as having physical effects, diabetes can have detrimental impacts on mental health [5, 6], disrupt socio-cultural practices ( relating to eating) [7, 8], and can have a negative influence on post-diagnosis identities [9, 10] People with both types of diabetes often experience social stigma relating to their condition and its treatment [11, 12]. Integrating the care provided by this diverse range of healthcare professionals can be challenging and, if not carefully constructed, such services can fail to focus on the people they are serving [13]
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