A Queensland-pioneered integrated primary/specialist model of community care in which a GP co-consults with an endocrinologist for complex type 2 diabetes has been validated in a WA study.
The WA study found patients’ cardiometabolic parameters improved while the modified Beacon model of care also relieved waiting lists at local hospital outpatient departments.
The Diabetes Complex Collaborative Care project (DCCC) enrolled 464 patients with a mean HbA1c of 9.3% and most in the overweight or obese weight range.
Limited de-identified baseline and follow-up data were available for all participants and almost half the study group (n=213) consented to a more detailed evaluation of their data such as biochemistry.
Patients were assessed by upskilled GPs and a management plan developed in consultation with an endocrinologist who also reviewed the patient if required.
The management plan was discussed with the patient and diabetes nurse educator and communicated to the patient’s usual GP. The aim of the project was to discharge patients back to their usual GP after one or two visits.
The nurse educator was available for further education and support via phone or face-to-face while other health professionals such as dieticians and podiatrists were involved as required.
The study, led by Professor Tim Davis from the University of Western Australia, found a significant intensification in diabetes treatment in the sub-group of patients with detailed data available.
In response, HbA1c reduced by about 1.2% over about 17 weeks from baseline and reduced further to 7.8% in a smaller group of patients with data available at 12 months.
There was a modest 1cm reduction in waist circumference from baseline to discharge from the program but no change in BMI or smoking status. Hypertension and blood lipids improved.
Patient reported a high rate of satisfaction with the program while referrals to the local hospital diabetes outpatient clinics and waiting times reduced while the DCCC was running.
“The present study shows that the community-based Beacon model can be used to improve management of complex type 2 diabetes when applied outside the Brisbane outer metropolitan practice setting in which it was developed,” the researchers said.
“We adapted the model to two large GP practices in the Western Australian health system and showed that glycaemic control and non-glycaemic cardiovascular risk factors improved significantly as a result of DCCC management in association with high levels of participant satisfaction and a positive impact on reductions in hospital outpatient clinic referrals and waiting times.”
Although the WA study did not have a comparator group, the most recent Beacon trial in Queensland included a usual hospital outpatient care arm and proved the Beacon model was non-inferior for glycaemic efficacy.
“This suggests that DCCC participants were not disadvantaged by utilising integrated care in the community rather than specialist clinics,” Professor Davis and colleagues said.
“Given that the need for specialist-directed diabetes care in Australia is almost certain to increase in an age of restricted hospital budgets and competing healthcare needs, the DCCC could be a sustainable solution to overburdened outpatient clinics for people with diabetes and perhaps other chronic conditions with a multidisciplinary management focus,” the WA study concluded.