A comparison of diabetes clinics with different emphasis on routine care, complications assessment and shared care

• Published in: Diabetic medicine Vol. 25; no. 8; pp. 974 - 978
• Main Authors: Cheung, N. W., Yue, D. K., Kotowicz, M. A., Jones, P. A., Flack, J. R.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.08.2008; Blackwell
• Subjects: Adult; Aged; Ambulatory Care Facilities - standards; Australia; Benchmarking; Biological and medical sciences; Diabetes Complications - diagnosis; Diabetes Complications - prevention & control; diabetes mellitus; Diabetes Mellitus - therapy; Diabetes. Impaired glucose tolerance; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Feeding. Feeding behavior; Female; Fundamental and applied biological sciences. Psychology; healthcare delivery; Humans; Male; Mass Screening - methods; Mass Screening - standards; Medical sciences; Middle Aged; models of care; outcomes; Patient Satisfaction; Primary Health Care - standards; Quality of Health Care - standards; Vertebrates: anatomy and physiology, studies on body, several organs or systems; Vertebrates: endocrinology; Australia; Endocrinopathy; Obesity; Prognosis; Nutrition; Health; healthcare delivery; Diabetes mellitus; Nutrition disorder; Metabolic diseases; Care; Clinic; models of care; outcomes; Complication; Evolution; Models; Endocrinology; Nutritional status; Comparative study
• ISSN: 0742-3071; 1464-5491
• DOI: 10.1111/j.1464-5491.2008.02522.x

Objective  To compare clinical outcomes of patients attending diabetes clinics with different models of care. Methods   Diabetes centres which participated in the Australian National Diabetes Information Audit and Benchmarking (ANDIAB) data collection were invited to nominate whether they provided (i) routine diabetes care only (model A), (ii) routine care and structured annual complications screening (model B) or (iii) annual review and complications screening in a system of shared care with general practitioners (model C). De‐identified case data were extracted from ANDIAB and outcomes according to the three clinic models were compared. Results  Data on 3052 patients from 18 diabetes centres were analysed. Centres which practised annual complications screening (models B and C) had higher rates of nephropathy and lipid screening and a higher rate of attainment of recommended blood pressure and glycated haemoglobin (HbA1c) targets. The implementation of appropriate treatment for patients who had not attained the targets was similar for all three clinic models. Conclusions  In our study, clinic models which incorporate a system of structured complications screening were more likely to have met screening guidelines. Patients in a shared‐care model were at least as likely to have met management targets as those attending diabetes clinics for their routine care. Therefore, a system of shared care by general practitioners supported by annual review at a diabetes clinic may be an acceptable model which improves the capacity to manage large numbers of people with diabetes, without loss of quality of care.