Challenges to Introducing Integrated Diabetes Care to an Inner-Regional Area in South Western Sydney, Australia

Abstract

Introduction: Diabetes care often requires collaboration between general practitioners, allied health professionals, nurses, and/or medical specialists. This study aimed to describe the establishment of an integrated diabetes prevention and care approach in an area with limited access to primary and secondary care, and the challenges faced in its initial development. Description: A qualitative research approach to identify challenges was taken. Data included meeting minutes, observational data and reports involving local clinical and non-clinical stakeholders from June 2016-December 2018 and were thematically analysed. Discussion: Key challenges were low patient attendance in general practice, healthcare professional time, low participation at health promotion activities/peer support groups and diabetes education reflecting a low priority among people with and at risk of diabetes. Coordination between services remained a challenge. Conclusion: This study highlights the need to integrate new diabetes services with existing health activities in the community and the importance of allowing flexibility and regular contact with local healthcare professional and community to encourage their involvement. Regular meetings with the funders, internal and external stakeholders are key for sustainability and to adapt programmes to the local situation. Further work is needed to identify and implement strategies to overcome these challenges.

Effectiveness of a locality‐based integrated diabetes care service on clinical outcomes

“…Strengths of the present study include the regular engagement with the external stakeholders and local healthcare professionals to address any challenges in a timely way. 10 A further strength is that the WDP programme was aligned with the strategic policy framework of New South Wales Health on integrated care guided by five focus areas: identifying, selecting and empowering patients, fostering innovative ways, prioritising primary and community care and sharing patient information electronically 25 (the latter was commenced 26 ). This alignment makes it more likely that the model can be scaled up.…”

“…The aim of the service was not to see all patients, but only those with need for specialist input. It is likely that some patients who may have benefited were not seen due to geographical dispersal, low personal priority for diabetes education, older patients unable to drive and other transport issues 10 . At times, practices nurses responsible for identifying patients for consultation were unable to prepare the patient referral due to other time commitments.…”

“…A diabetes specialist team (endocrinologist, dietitian, credentialed diabetes educator and podiatrist) provided: (i) case conferencing based in practices where complex cases were discussed between the visiting WDP endocrinologist, GP and an allied health professional/practice nurse, organised by general practitioners with patient consent 10 . Patients were not present for this service.…”

“…9 There are 11 general practitioner (GP) practices in the area with a low GP : people ratio (1:2960). 10 Due to distance and geography, some residents live closer to GP in neighbouring local government areas (LGA).…”

“…The Wollondilly Diabetes Programme (WDP) started in 2016, funded by the Wollondilly Health Alliance to facilitate the joint working between South Western Sydney Local Health District, South Western Sydney Primary Health Network and Wollondilly Shire Council. 10 The WDP is an integrated diabetes care service offering clinical and prevention services (as previously described). It aims to support management of people with Type 2 diabetes (directly or indirectly through primary care), prevent/delay diabetes complications onset and prevent people at risk from developing diabetes.…”