An Innovative Model of Diabetes Care and Delivery: The St. Joseph's Primary Care Diabetes Support Program (SJHC PCDSP)

Reichert, Sonja M.; Harris, Stewart B.; Harvey, Betty

doi:10.1016/j.jcjd.2014.03.008

Cited by 10 publications

(6 citation statements)

References 10 publications

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“…Ontario COVID-19–related physical distancing policies were in place throughout the study period, with strict stay-at-home orders for 9 out of 16 weeks [ 6 ]. Despite well-documented pandemic-related recruitment challenges [ 7 ], we sought to recruit a convenience sample of 10 to 20 new patient intakes [ 8 - 12 ] from St Joseph’s Primary Care Diabetes Support Program, a London, Ontario, diabetes outpatient clinic serving higher-risk, lower-income adults [ 13 ]. Prospective participants, physician-cleared to exercise and with access to a smartphone (ie, iPhone 7 iOS or higher or Android [operating system 5 or higher]), were invited to a study recruitment session by their physicians during usual care.…”

Section: Methodsmentioning

confidence: 99%

Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study

Hiemstra,

Reichert,

Mitchell

2024

JMIR Form Res

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Background To date, most group-based diabetes self-management education (DSME) programs for type 2 diabetes (T2D) have been delivered in person. The rapid transition to remote care at the outset of the COVID-19 pandemic presented opportunities to test, evaluate, and iterate a new remote DSME program. Objective We aim to refine the delivery and evaluation of a multicomponent remote DSME program for adults living with T2D by examining several feasibility outcomes. Methods We recruited a convenience sample of patients from a London, Canada, outpatient diabetes clinic (serving high-risk, low-income adults) to participate in a 6-week, single cohort feasibility study from November 2020 to March 2021. This small ORBIT phase 1b feasibility study represents the first in a planned series guided by the ORBIT model for developing behavioral interventions for chronic diseases (phase 1: design; phase 2: preliminary testing; phase 3: efficacy; and phase 4: effectiveness). The feasibility of delivering and evaluating a remote DSME program, including (1) live video education classes, (2) individualized physical activity (PA) prescription and counseling, and (3) intermittently scanned continuous glucose and wearable PA monitoring, was assessed. Feasibility outcomes included recruitment and retention rates, program adherence, and acceptability (ie, technology issues and exit survey feedback). PA was assessed with Fitbit Inspire 2 (Fitbit Inc) and estimated glycated hemoglobin (HbA1c) using the FreeStyle Libre (Abbot). Given the small study sample, group- and individual-level data are reported descriptively. Results A total of 10 adults living with T2D were recruited (female 60%; age 49.9, SD 14.3 years; estimated HbA1c 6.2%, SD 0.5%). Recruitment and retention rates were 29% and 80%, respectively. Participants attended 83% (25/30) and 93% (37/40) of education classes and PA counseling phone calls, respectively. There were 3.2 (SD 2.6) technology issues reported per person, most of which were related to study data transfer. Exit survey responses suggest most participants (8/9, 89%) were “satisfied” with the program. Recognizing the small sample size and the fact that no inferential statistics were conducted, the mean (SD) for the weekly daily step count and estimated HbA1c are provided for illustrative purposes. Participants accumulated 7103 (SD 2900) and 7515 (SD 3169) steps per day at baseline and week 6, respectively. The estimated HbA1c was 6.2% (SD 0.5%) and 6.2% (SD 0.6%) at baseline and week 6, respectively. Conclusions This ORBIT phase 1b study served to refine the delivery (eg, automatic study data upload process recommended to reduce participant burden) and evaluation (eg, purposeful sampling of participants with baseline HbA1c >8% recommended to address selection bias) of a remote DSME program. Preliminary proof-of-concept testing (ORBIT phase 2) incorporating some of these learnings is now warranted. Trial Registration ClinicalTrials.gov NCT04498819; https://clinicaltrials.gov/study/NCT04498819

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Section: Methodsmentioning

confidence: 99%

Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study

Hiemstra,

Reichert,

Mitchell

2024

JMIR Form Res

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show abstract

“… 20–22 In addition to promoting diabetes self-management typical of diabetes education programmes, nurse practitioners and focused-practice family physicians with specialised training in diabetes management provide active medical management and a social services worker addresses the social determinants of health. 11 23 The team-based approach is supported by WebDR, a built-for-purpose electronic medical record developed for diabetes outpatient clinics that also serves as a researchable database. 11 24 …”

Section: Introductionmentioning

confidence: 99%

“… 11 23 The team-based approach is supported by WebDR, a built-for-purpose electronic medical record developed for diabetes outpatient clinics that also serves as a researchable database. 11 24 …”

Section: Introductionmentioning

confidence: 99%

“…Unlike evaluations of diabetes interventions that focus on biological markers, 21 25 this project examines the impact of the PCDSP on diabetes complications, which are not only associated with increased health service utilisation and costs 7 26 but also with reduced patient satisfaction 27 and quality of life. 19 While routine quality improvement data demonstrate that the PCDSP improves blood glucose levels and other clinical indicators associated with better diabetes outcomes, 11 its broader impact on patient and provider experiences, diabetes complications and health system costs has not been evaluated.…”

Section: Introductionmentioning

confidence: 99%

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Evaluation of a unique and innovative diabetes care model in primary care in Ontario, Canada: protocol for a multiple-methods study with a convergent parallel design

Mathews,

Lyons,

Harris

et al. 2024

BMJ Open

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IntroductionThe growth and complexity of diabetes are exceeding the capacity of family physicians, resulting in the demand for community-based, interprofessional, primary care-led transition clinics. The Primary Care Diabetes Support Programme (PCDSP) in London, Ontario, is an innovative approach to diabetes care for high-risk populations, such as medically or socially complex and unattached patients. In this study, we will employ a quadruple-aim approach to evaluate the health system impacts of the PCDSP.Methods and analysisWe will use multiple methods through a convergent parallel design in this project across five unique studies: a case study, a patient study, a provider study, a complications study and a cost-effectiveness study. The project will be conducted in a dedicated stand-alone clinic specialising in chronic disease management, specifically focusing on diabetes care. Participants will include clinic staff, administrators, family physicians, specialists and patients with type 1 or type 2 diabetes who received care at the clinic between 2011 and 2023. The project design will define the intervention, support replication at other sites or for other chronic diseases and address each of the quadruple aims and equity. Following the execution of the five individual studies, we will build a business case by integrating the results. Data will be analysed using both qualitative (content analysis and thematic analysis) and quantitative techniques (descriptive statistics and multiple logistic regression).Ethics and disseminationWe received approval from the research ethics boards at Western University (reference ID: 2023–1 21 766; 2023–1 22 326) and Lawson Health Research Institute (reference ID: R-23–202). A privacy review was completed by St. Joseph’s Healthcare Corporation. The findings will be shared among PCDSP staff and patients, stakeholders, academic researchers and the public through stakeholder sessions, conferences, peer-reviewed publications, infographics, posters, media interviews, social media and online discussions. For the patient and provider study, all participants will be asked to provide consent and are free to withdraw from the study, without penalty, until the data are combined. Participants will not be identified in any report or presentation except in the case study, for which, given the number of PCDSP providers, we will seek explicit consent to identify them.

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“…In an effort to reform and improve PHC delivery, the Ontario Ministry of Health and Long Term Care (MOHLTC) established Family Health Teams (FHTs) in 2005. 4–6 These new models were envisioned as a multidisciplinary, team-based, patient-centered, and proactive healthcare delivery system focused on health promotion, disease prevention and chronic disease management. To help FHTs navigate this transition, the provincial Quality Improvement and Innovation Partnership (QIIP), now amalgamated with Health Quality Ontario (HQO), was established in 2005 by the MOHLTC.…”

Section: Introductionmentioning

confidence: 99%

Impact of a primary healthcare quality improvement program on diabetes in Canada: evaluation of the Quality Improvement and Innovation Partnership (QIIP)

Reichert

Harris

Tompkins

et al. 2017

BMJ Open Diab Res Care

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ObjectivePrimary healthcare (PHC) quality improvement (QI) initiatives are designed to improve patient care and health outcomes. We evaluated the Quality Improvement and Innovation Partnership (QIIP), an Ontario-wide PHC QI program on access to care, diabetes management and colorectal cancer screening. This manuscript highlights the impact of QIIP on diabetes outcomes and associated vascular risk factors.Research design and methodsA cluster matched-control, retrospective prechart and postchart audit was conducted. One physician per QIIP-PHC team (N=34) and control (N=34) were recruited for the audit. Eligible charts were reviewed for prespecified type 2 diabetes mellitus clinical process and outcome data at baseline, during (intervention range: 15–17.5 months) and post. Primary outcome measures were the A1c of patients above study target and proportion of patients with an annual foot exam. Secondary outcome measures included glycemic, hypertension and lipid outcomes and management, screening for diabetes-related complications, healthcare utilization, and diabetes counseling, education and self-management goal setting.ResultsMore patients in the QIIP group achieved statistically improved lipid testing, eye examinations, peripheral neuropathy exams, and documented body mass index. No statistical differences in A1c, low-density lipoprotein or systolic/diastolic blood pressure values were noted, with no significant differences in medication prescription, specialist referrals, or chart-reported diabetes counseling, education or self-management goals. Patients of QIIP physicians had significantly more PHC visits.ConclusionThe QIIP-learning collaborative program evaluation using stratified random selection of participants and the inclusion of a control group makes this one of the most rigorous and promising efforts to date evaluating the impact of a QI program in PHC. The chart audit component of this evaluation highlighted that while QIIP improved some secondary diabetes measures, no improvements in clinical outcomes were noted. This study highlights the importance of formalized evaluation of QI initiatives to provide an evidence base to inform future program planning and scale-up.

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An Innovative Model of Diabetes Care and Delivery: The St. Joseph's Primary Care Diabetes Support Program (SJHC PCDSP)

Cited by 10 publications

References 10 publications

Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study

Examining a Remote Group-Based Type 2 Diabetes Self-Management Education Program in the COVID-19 Era Using the ORBIT Model: Small 6-Week Feasibility Study

Evaluation of a unique and innovative diabetes care model in primary care in Ontario, Canada: protocol for a multiple-methods study with a convergent parallel design

Impact of a primary healthcare quality improvement program on diabetes in Canada: evaluation of the Quality Improvement and Innovation Partnership (QIIP)

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