A model-based evaluation of collaborative care in management of patients with type 2 diabetes in Australia: an initial report

2012 ◽  
Vol 36 (3) ◽  
pp. 258 ◽  
Author(s):  
Hossein Haji Ali Afzali ◽  
Jonathan Karnon ◽  
Jodi Gray ◽  
Justin Beilby
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Models Of Care ◽  
Costs And Benefits ◽  
Initial Report ◽  
Alternative Models ◽  
Routinely Collected Data ◽  
General Practices

Objectives. To analyse the short- and long-term costs and benefits of alternative models of primary care for the management of patients with type 2 diabetes in Australia. The models of care reflect differential uptake of primary care-based incentive programs, including reminder systems and involvement of practice nurses in management. This paper describes our study protocol and its progress. Methods. We are undertaking an observational study using a cluster sample design that links retrospective patient data from a range of sources to estimate costs and intermediate outcomes (such as the level of glycosylated haemoglobin (HbA1c)) over a 3-year time horizon. We use the short-term data as a basis to estimate lifetime costs and benefits of alternative models of care using a decision analytic model. Initial report. We recruited 15 practices from a metropolitan area (Adelaide) and allocated them to three models of care. Three hundred and ninety-nine patients agreed to participate. We use multilevel analysis to evaluate the association between different models of care and patient-level outcomes, while controlling for several covariates. Discussion/conclusions. Given the large amount of funding currently used to maintain primary care-based incentives in general practices in Australia, the results of this study generate the knowledge required to promote investment in the most cost-effective incentives. What is known about the topic? Collaborative models of care can improve the outcomes in patients with chronic diseases such as type 2 diabetes (T2D), and the large amount of funding is currently used to maintain primary care-based initiatives to provide incentives for general practices to take a more multidisciplinary approach in management of chronic diseases. What does this paper add? There are few model-based studies of the cost-effectiveness of alternative models of care defined on the basis of the uptake of financial incentives within Australian primary care settings for diabetes management. Using routinely collected data, this project evaluates the effectiveness of alternative models of care and estimates long-term costs and benefits of various models of care. What are the implications for practitioners? This study explores opportunities for the use of linked, routinely collected data to evaluate clinical practice, and identifies the optimal model of care in management of patients with T2D, with respect to differences in long-term costs and outcomes.

scholarly journals Multimorbidity and achievement of treatment goals among patients with type 2 diabetes: a primary care, real-world study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Eveliina Heikkala ◽  
Ilona Mikkola ◽  
Jari Jokelainen ◽  
Markku Timonen ◽  
Maria Hagnäs
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Health Care ◽  
Primary Health Care ◽  
Treatment Target ◽  
Adequate Treatment ◽  
Treatment Targets ◽  
Primary Health

Abstract Background Type 2 diabetes (T2D), with its prevalence and disability-causing nature, is a challenge for primary health care. Most patients with T2D are multimorbid, i.e. have one or more long-term diseases in addition to T2D. Multimorbidity may play a role in the achievement of T2D treatment targets, but is still not fully understood. The aims of the present cross-sectional, register-based study were to evaluate the prevalence and the most common patterns of multimorbidity among patients with T2D; and to study the potential associations between multimorbidity and treatment goal achievement, including measurements of glycosylated haemoglobin A1c (HbA1c), low-density lipoprotein (LDL) and systolic blood pressure (sBP). Methods The study population consisted of 4545 primary care patients who received a T2D diagnosis between January 2011 and July 2019 in Rovaniemi Health Centre, Finland. Data on seven long-term concordant (T2D-related) diseases, eight long-term discordant (non-T2D-related) diseases, potential confounders (age, sex, body mass index, prescribed medication), and the outcomes studied were collected from patients’ records. Logistic regression models with odds ratios (ORs) and 95 % confidence intervals (CIs) were assessed to determine the associations between multimorbidity and the achievement of treatment targets. Results Altogether, 93 % of the patients had one or more diseases in addition to T2D, i.e. were considered multimorbid. Furthermore, 21 % had only concordant disease(s) (Concordant subgroup), 8 % had only discordant disease(s) (Discordant subgroup) and 64 % had both (Concordant and discordant subgroup). As either single diseases or in combination with others, hypertension, musculoskeletal (MS) disease and hyperlipidaemia were the most prevalent multimorbidity patterns. Being multimorbid in general (OR 1.32, CI 1.01–1.70) and belonging to the Concordant (OR 1.45, CI 1.08–1.95) and Concordant and discordant (OR 1.31, CI 1.00–1.72) subgroups was associated with achievement of the HbA1c treatment target. Belonging to the Concordant and discordant subgroup was related to meeting the LDL treatment target (OR 1.31, CI 1.00–1.72). Conclusions Multimorbidity, including cardiovascular risk and the musculoskeletal disease burden, was extremely prevalent among the T2D patients who consulted primary health care. Primary care clinicians should survey the possible co-existence of long-term diseases among T2D patients to help maintain adequate treatment of T2D.

scholarly journals Evaluating the effectiveness of a support programme for people with type 2 diabetes mellitus in primary care: an observational prospective study in Ecuador

BJGP Open ◽  
2020 ◽  
Vol 4 (2) ◽  
pp. bjgpopen20X101025
Author(s):  
Francisco Barrera-Guarderas ◽  
Katherine De la Torre-Cisneros ◽  
Maria Barrionuevo-Tapia ◽  
Carmen Cabezas-Escobar
Keyword(s):  
Diabetes Mellitus ◽  
Blood Pressure ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Type 2 Diabetes Mellitus ◽  
Ocular Fundus ◽  
Network Support ◽  
Support Programme

BackgroundThe success of primary health care relies on the integration of empowered practitioners with cooperative patients regardless of socioeconomic status. Using resources efficiently would help to improve healthcare promotion and reduce complications of chronic non-communicable diseases (NCDs). The importance of network support programmes relies on the fact that they allow to accurately deliver medical care by shaping a sense of community and purpose among the patients.AimTo evaluate the effectiveness of a network support programme for patients with type 2 diabetes mellitus (T2DM).Design & settingA centre-based observational prospective study took place in a primary care setting in Ecuador.MethodThe impact of the diabetes care programme was assessed by comparing initial and final metabolic characteristics and outcomes of 593 patients with T2DM, followed-up from April 2007 to December 2017, using paired sample t-test. Electrocardiograms (ECGs), ankle-brachial indexes (ABIs), ocular fundus, and monofilament neuropathy tests were assessed with the McNemar test to evaluate complications at the beginning and end of the study.ResultsGlycated haemoglobin (HbA1c), lipid profile, and systolic blood pressure (SBP) showed statistically significant decreases between the initial measurement (IMs) and final measurements (FMs). In the FM, significantly lower HbA1c, diastolic blood pressure (DBP), and atherogenic index were found. Despite the length of time since diagnosis, during the follow-up time, long-term micro- and macro-vascular complications, such as ocular fundus, serum creatinine, and ABI, remained unchanged throughout the period of active participation in this healthcare programme.ConclusionThis study demonstrates the feasibility of reducing plasma glucose, plasma lipids, and long-term complications in patients with T2DM by implementing a network support programme, which involves the medical team and patients themselves in an environment with limited resources.

scholarly journals Quality of Care for Patients With Type 2 Diabetes in Primary Care in Norway Is Improving: Results of cross-sectional surveys of 33 general practices in 1995 and 2005

Diabetes Care ◽  
2008 ◽  
Vol 32 (1) ◽  
pp. 81-83 ◽  
Author(s):  
J. G. Cooper ◽  
T. Claudi ◽  
A. K. Jenum ◽  
G. Thue ◽  
M. F. Hausken ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Quality Of Care ◽  
Cross Sectional ◽  
General Practices

Expectations and fear of diabetes-related long-term complications in people with type 2 diabetes at primary care level

2018 ◽  
Vol 56 (1) ◽  
pp. 33-38 ◽  
Author(s):  
Nadine Kuniss ◽  
Michael Freyer ◽  
Nicolle Müller ◽  
Volker Kielstein ◽  
Ulrich A. Müller
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Care Level ◽  
Primary Care Level

scholarly journals Can process mining automatically describe care pathways of patients with long-term conditions in UK primary care? A study protocol

BMJ Open ◽  
2018 ◽  
Vol 8 (12) ◽  
pp. e019947 ◽  
Author(s):  
Ian Litchfield ◽  
Ciaron Hoye ◽  
David Shukla ◽  
Ruth Backman ◽  
Alice Turner ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Primary Care ◽  
Process Mining ◽  
Process Models ◽  
Ageing Population ◽  
Long Term Conditions ◽  
Care Processes ◽  
The Uk

IntroductionIn the UK, primary care is seen as the optimal context for delivering care to an ageing population with a growing number of long-term conditions. However, if it is to meet these demands effectively and efficiently, a more precise understanding of existing care processes is required to ensure their configuration is based on robust evidence. This need to understand and optimise organisational performance is not unique to healthcare, and in industries such as telecommunications or finance, a methodology known as ‘process mining’ has become an established and successful method to identify how an organisation can best deploy resources to meet the needs of its clients and customers. Here and for the first time in the UK, we will apply it to primary care settings to gain a greater understanding of how patients with two of the most common chronic conditions are managed.Methods and analysisThe study will be conducted in three phases; first, we will apply process mining algorithms to the data held on the clinical management system of four practices of varying characteristics in the West Midlands to determine how each interacts with patients with hypertension or type 2 diabetes. Second, we will use traditional process mapping exercises at each practice to manually produce maps of care processes for the selected condition. Third, with the aid of staff and patients at each practice, we will compare and contrast the process models produced by process mining with the process maps produced via manual techniques, review differences and similarities between them and the relative importance of each. The first pilot study will be on hypertension and the second for patients diagnosed with type 2 diabetes.Ethics and disseminationEthical approval has been provided by East Midlands–Leicester South Regional Ethics Committee (REC reference 18/EM/0284). Having refined the automated production of maps of care processes, we can explore pinch points and bottlenecks, process variants and unexpected behaviour, and make informed recommendations to improve the quality and efficiency of care. The results of this study will be submitted for publication in peer-reviewed journals.

Long-term cost-effectiveness of a Patient Empowerment Programme for type 2 diabetes mellitus in primary care

2018 ◽  
Vol 21 (1) ◽  
pp. 73-83 ◽  
Author(s):  
Jinxiao Lian ◽  
Sarah M. McGhee ◽  
Ching So ◽  
June Chau ◽  
Carlos K. H. Wong ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Primary Care ◽  
Type 2 Diabetes Mellitus ◽  
Cost Effectiveness ◽  
Patient Empowerment
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