The Specialist And Primary Physicians Health Initiative to Reduce Endpoints in Diabetes (SAPPHIRE) Study: A Novel Type 2 Diabetes Care Delivery Model to Improve Glycemic Control in Hong Kong

Abstract

SAPPHIRE is a shared-care diabetes quality improvement program that supports family physicians caring for patients, involving trained nurses that perform comprehensive assessments (CA), electronic care protocols, validated risk engines and specialist-reviewed assessment reports. SAPPHIRE patients are more likely to achieve a significant reduction in A1C (≥0.5%) over 1 year than usual care (UC). This was a case-control study evaluating SAPPHIRE versus UC at a family medicine clinic. Diabetes patients were offered SAPPHIRE, and those who agreed were seen yearly for CA at the Prince of Wales Hospital Diabetes Centre. Assessment reports were given to patients and their family physicians. Case controls for UC group were chosen from type 2 diabetes patients attending the same clinic, and had baseline and 1-year follow up A1C recorded while receiving usual primary care. Logistic regression was used to adjust for confounding and identifying predictors of significant A1C change after 1 year. Six hundred seventy-seven SAPPHIRE and 466 UC patients were included in the analyses, where baseline mean age (60.4±10.9 vs. 62.7±9.6 years, p<0.001) and A1C (6.8±1.1% vs. 7.16±1.0%, p<0.001) differed significantly. Forty seven percent were male, with 6.8±5.8 year mean disease duration. After 1 year, 26% of patients in each group had achieved significant A1C reduction. After adjusting for confounders, participation in SAPPHIRE emerged as an independent predictor of achieving significant reduction in A1C (OR 1.58, 95% CI 1.11 to 2.25; p=0.011). Involvement in SAPPHIRE significantly improved glycemic control, providing impetus to redesign diabetes care delivery to incorporate trained support teams and effective technologies.