Cost-Effectiveness Evaluation of Collaborative Care for Diabetes and Depression in Primary Care

Johnson, Jeffrey; Lier, Doug; Soprovich, Allison; Sayah, Fatima Al; Qiu, Weiliang; Majumdar, Sumit R.

doi:10.1016/j.amepre.2016.01.010

Cited by 20 publications

(27 citation statements)

References 32 publications

(51 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, we are collecting detailed information to conduct a comprehensive economic evaluation, assessing the cost-effectiveness of RADAR specific to these communities. Our approach to the economic analysis will be analogous to methods previously published by our group [ 21 , 22 ].…”

Section: Methodsmentioning

confidence: 99%

Addressing the gaps in diabetes care in first nations communities with the reorganizing the approach to diabetes through the application of registries (RADAR): the project protocol

Eurich

Majumdar

Wozniak

et al. 2017

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

BackgroundType-2 diabetes rates in First Nations communities are 3-5 times higher than the general Canadian population, resulting in a high burden of disease, complications and comorbidity. Limited community nursing capacity, isolated environments and a lack of electronic health records (EHR)/registries lead to a reactive, disorganized approach to diabetes care for many First Nations people. The Reorganizing the Approach to Diabetes through the Application of Registries (RADAR) project was developed in alignments with federal calls for innovative, culturally relevant, community-specific programs for people with type-2 diabetes developed and delivered in partnership with target communities.MethodsRADAR applies both an integrated diabetes EHR/registry system (CARE platform) and centralized care coordinator (CC) service that will support local healthcare. The CC will work with local healthcare workers to support patient and community health needs (using the CARE platform) and build capacity in best practices for type-2 diabetes management. A modified stepped wedge controlled trial design will be used to evaluate the model. During the baseline phase, the CC will work with local healthcare workers to identify patients with type-2 diabetes and register them into the CARE platform, but not make any management recommendations. During the intervention phase, the CC will work with local healthcare workers to proactively manage patients with type-2 diabetes, including monitoring and recall of patients, relaying clinical information and coordinating care, facilitated through the shared use of the CARE platform. The RE-AIM framework will provide a comprehensive assessment of the model.The primary outcome measure will be a 10% improvement in any one of A1c, BP, or cholesterol over the baseline values. Secondary endpoints will address other diabetes care indicators including: the proportion of clinical measures completed in accordance with guidelines (e.g., foot and eye examination, receipt of vaccinations, smoking cessation counseling); the number of patients registered in CARE; and the proportion of patients linked to a health services provider. The cost-effectiveness of RADAR specific to these communities will be assessed. Concurrent qualitative assessments will provide contextual information, such as the quality/usability of the CARE platform and the impact/satisfaction with the model.DiscussionRADAR combines innovative technology with personalized support to deliver organized diabetes care in remote First Nations communities in Alberta. By improving the ability of First Nations to systematically identify and track diabetes patients and share information seamlessly an overall improvement in the quality of clinical care of First Nations people living with type-2 diabetes on reserve is anticipated.Trial registrationISRCTN study ID ISRCTN14359671, retrospectively registered October 7, 2016.

show abstract

Section: Methodsmentioning

confidence: 99%

Addressing the gaps in diabetes care in first nations communities with the reorganizing the approach to diabetes through the application of registries (RADAR): the project protocol

Eurich

Majumdar

Wozniak

et al. 2017

BMC Health Serv Res

Self Cite

View full text Add to dashboard Cite

show abstract

Section: Introductionmentioning

confidence: 99%

Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

Foo

Surendran

Tam

et al. 2020

Preprint

View full text Add to dashboard Cite

Background The increasing chronic disease burden in developed countries has placed tremendous strain on tertiary healthcare infrastructure and resources. Therefore, there is an urgent need to shift chronic disease management from tertiary to primary care providers to mitigate the increase in demand for chronic care at hospitals. The organization of private general practitioners (GPs) into Primary Care Networks (PCNs) is a pragmatic move by Singapore, a developed and multi-ethnic urban city, to provide private GPs with team-based care capabilities and a platform to track care indicators for better management of chronic patients. As the PCN initiative is still in its embryonic stages, there is a void in research regarding its ability to empower private GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by private GPs in the PCN. Method: We conducted 30 semi-structured in-depth interviews with GPs enrolled in a PCN. Qualitative analysis of audio transcripts was performed to extract themes which highlighted the facilitators and barriers faced by PCN in the early stages of its development. Results Our results suggest that PCNs facilitated private GPs to more effectively manage chronic patients through 1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a “one-stop-shop”, 2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and 3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions. Conclusion PCNs demonstrate great promise in empowering and motivating private GPs to manage chronic patients. However, barriers will need to be addressed to ensure the quality and comprehensiveness of PCNs in managing more chronic patients in the face of an ageing population.

show abstract

“…PCNs implemented in Alberta had demonstrated their capacities in reducing presentations to emergency departments and hospital days for non-elective acute care, further emphasizing the signi cance of team-based care at the primary care interface [24,25]. Two studies by Johnson et al (2016) also demonstrated PCN's team-based approach to care for diabetic and depressed patients as a cost-effective management strategy [26,27]. Furthermore, PCNs can facilitate sharing of resources, allowing for greater bargaining power when tendering for services, sharing expertise between parties and reducing the organizational workload of practices [28].…”

Section: Introductionmentioning

confidence: 99%

Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

Foo

Surendran

Tam

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: The increasing chronic disease burden in developed countries has placed tremendous strain on tertiary healthcare infrastructure and resources. Therefore, there is an urgent need to shift chronic disease management from tertiary to primary care providers to mitigate the increase in demand for chronic care at hospitals. The organization of private general practitioners (GPs) into Primary Care Networks (PCNs) is a pragmatic move by Singapore, a developed and multi-ethnic urban city, to provide private GPs with team-based care capabilities and a platform to track care indicators for better management of chronic patients. As the PCN initiative is still in its embryonic stages, there is a void in research regarding its ability to empower private GPs to manage chronic patients effectively. This qualitative study aims to explore the facilitators and barriers for the management of chronic patients by private GPs in the PCN. Method: We conducted 30 semi-structured in-depth interviews with GPs enrolled in a PCN. Qualitative analysis of audio transcripts was performed to generate themes which highlighted the facilitators and barriers faced by PCN in the early stages of its development. Results: Our results suggest that PCNs facilitated private GPs to more effectively manage chronic patients through 1) provision of ancillary services such as diabetic foot screening, diabetic retinal photography and nurse counselling to permit a “one-stop-shop”, 2) systematic monitoring of process and clinical outcome indicators through a chronic disease registry (CDR) to promote accountability for patients’ health outcomes and 3) funding streams for PCNs to hire additional manpower to oversee operations and to reimburse GPs for extended consultations. Barriers include high administrative load in maintaining the CDR due to the lack of a smart electronic clinic management system and financial gradient faced by patients seeking services from private GPs which incur higher out-of-pocket expenses than public primary healthcare institutions.Conclusion: PCNs demonstrate great promise in empowering and motivating private GPs to manage chronic patients. However, barriers will need to be addressed to ensure the quality and comprehensiveness of PCNs in managing more chronic patients in the face of an ageing population.

show abstract

Cost-Effectiveness Evaluation of Collaborative Care for Diabetes and Depression in Primary Care

Cited by 20 publications

References 32 publications

Addressing the gaps in diabetes care in first nations communities with the reorganizing the approach to diabetes through the application of registries (RADAR): the project protocol

Addressing the gaps in diabetes care in first nations communities with the reorganizing the approach to diabetes through the application of registries (RADAR): the project protocol

Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

Perceived facilitators and barriers to chronic disease management in primary care networks: a qualitative study

Contact Info

Product

Resources

About