‘Working with the team’: an exploratory study of improved type 2 diabetes management in a new model of integrated primary/secondary care

Abstract

This study aimed to explore how a new model of integrated primary/secondary care for type 2 diabetes management, the Brisbane South Complex Diabetes Service (BSCDS), related to improved diabetes management in a selected group of patients. We used a qualitative research design to obtain detailed accounts from the BSCDS via semi-structured interviews with 10 patients. The interviews were fully transcribed and systematically coded using a form of thematic analysis. Participants' responses were grouped in relation to: (1) Patient-centred care; (2) Effective multiprofessional teamwork; and (3) Empowering patients. The key features of this integrated primary/secondary care model were accessibility and its delivery within a positive health care environment, clear and supportive interpersonal communication between patients and health care providers, and patients seeing themselves as being part of the team-based care. The BSCDS delivered patient-centred care and achieved patient engagement in ways that may have contributed to improved type 2 diabetes management in these participants.

Making sense of change: patients’ views of diabetes and GP‐led integrated diabetes care

“…How this alliance ‘plays out’ is important in the process of change to achieve effective self‐care and improved quality of life. While a previous pilot study found that patients appreciated being treated as co‐members of their diabetes care team, the finding of participants’ satisfaction with a compliant role, is only partially supported in the present research. In the complexities of managing diabetes in their life context, some participants found that rule‐keeping did not work as well as their own experimental fine‐tuning of health professionals’ advice.…”

“…Management in the primary care setting by general practitioners (GPs) is common for most people with type 2 diabetes in Australia . Further, it is widely acknowledged that primary care is critical to the diagnosis and quality improvement in diabetes care .…”

Impact of an integrated model of care on potentially preventable hospitalizations for people with Type 2 diabetes mellitus

“…Furthermore, once patients were hospitalized there did not appear to be any difference in length of stay, suggesting that there is no evidence that the severity of conditions for which hospitalization was necessary differed between groups. It has been demonstrated previously that patients receiving our innovative integrated model of care show greater improvements in HbA 1c concentration, blood pressure and total cholesterol [18] and value the accessibility and supportive interpersonal care provided by the multidisciplinary integrated care team [20]. In view of the spiralling costs of healthcare delivery, these positive findings confirm, in the Australian context, the results of previous international studies that comprehensive multidisciplinary care for diabetes patients can reap substantial short-term and long-term improvements in healthcare utilisation costs as well as patient outcomes [26][27][28].…”

“…Integrated care is now indicated as beneficial for most chronic diseases [15] and is gaining support as an effective approach to overcome fragmentation and deliver better health outcomes for people with complex chronic disease [16,17]. Recent Australian research evaluated an integrated primary-secondary model of care for people with complex Type 2 diabetes and demonstrated the positive impact of the model on care quality and service cost [18][19][20]. The present study augments the evaluation of this model of care by investigating the effects of the model on PPHs for diabetes-related complications.…”

Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial

“…Further studies are currently undertaking a more detailed cost analysis. Qualitative research has identified the success factors of the model from a patient perspective as accessibility, a positive healthcare environment and clear and supportive interpersonal communication with healthcare providers [28].…”