Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES—Australia

Skinner, Timothy; Allen, Penny; Peach, Elizabeth; Browne, Jessica L.; Pouwer, Frans; Speight, Jane; Dunbar, James

doi:10.1016/j.diabres.2013.03.015

Cited by 17 publications

(15 citation statements)

References 27 publications

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“…Mixed evidence is found in the care of diabetes. Driving distance has not been associated with care outcomes within urban settings in Canada [ 40 ], and differences in care outcomes have not been found between rural and urban patients in Australia and the USA [ 41 , 42 ]. In some cases driving distance has been associated with care outcomes in rural areas in the USA [ 43 , 44 ].…”

Section: Introductionmentioning

confidence: 99%

Do the classification of areas and distance matter to the assessment results of achieving the treatment targets among type 2 diabetes patients?

et al. 2015

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Background: Type 2 diabetes is a major health concern all over the world. The prevention of diabetes is important but so is well-balanced diabetes care. Diabetes care can be influenced by individual and neighborhood socio-economic factors and geographical accessibility to health care services. The aim of the study is to find out whether two different area classifications of urban and rural areas give different area-level results of achieving the targets of control and treatment among type 2 diabetes patients exemplified by a Finnish region. The study exploits geo-referenced patient data from a regional primary health care patient database combined with postal code area-level socio-economic variables, digital road data and two grid based classifications of areas: an urban-rural dichotomy and a classification with seven area types. Methods:The achievement of control and treatment targets were assessed using the patient's individual laboratory data among 9606 type 2 diabetes patients. It was assessed whether hemoglobin A1c (HbA1c) was controlled and whether the recommended level of HbA1c was achieved in patients by different area classes and as a function of distance. Chi square test and logistic regression analysis were used for testing. Results:The study reveals that area-level inequalities exist in the care of type 2 diabetes in a detailed 7-class area classification but if the simple dichotomy of urban and rural is applied differences vanish. The patient's gender and age, area-level education and the area class they belonged to were associated with achievements of control and treatment targets. Longer distance to health care services was not a barrier to good achievements of control or treatment targets. Conclusions:A more detailed grid-based area classification is better for showing spatial differences in the care of type 2 diabetes patients. Inequalities exist but it would be misleading to state that the differences are simply due to urban or rural location or due to distance. From a planning point of view findings suggest that detailed geo-coded patient information could be utilized more in resourcing and targeting the health care services to find the area-level needs of care and to improve the cost-efficient allocation of resources.

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Section: Introductionmentioning

confidence: 99%

Do the classification of areas and distance matter to the assessment results of achieving the treatment targets among type 2 diabetes patients?

et al. 2015

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“…For example, in Canada, a 2005 study indicated that 19% of Canadians who visited a specialist reported difficulty accessing care . Similar problems have been reported in Australia .…”

Section: Unanswered Questions and Challengesmentioning

confidence: 75%

Short‐term intensive insulin therapy at diagnosis in type 2 diabetes: plan for filling the gaps

Weng

Retnakaran

et al. 2014

Diabetes Metabolism Res

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SummaryShort-term intensive insulin therapy is unique amongst therapies for type 2 diabetes because it offers the potential to preserve and improve beta-cell function without additional pharmacological treatment. On the basis of clinical experience and the promising results of a series of studies in newly diagnosed patients, mostly in Asian populations, an expert workshop was convened to assess the available evidence and the potential application of short-term intensive insulin therapy should it be advocated for inclusion in clinical practice. Participants included primary care physicians and endocrinologists. We endorse the concept of short-term intensive insulin therapy as an option for some patients with type 2 diabetes at the time of diagnosis and have identified the following six areas where additional knowledge could help clarify optimal use in clinical practice: (1) generalizability to primary care, (2) target population and biomarkers, (3) follow-up treatment, (4) education of patients and providers, (5) relevance of ethnicity, and (6) health economics.

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“…This is especially important in rural regions in which specialised services are less accessible than in urban areas. 24 This rapid review evaluated which (if any) interventions targeted at primary health care providers led to positive changes in outcomes in patients with T2D. We identified 15 studies (one systematic review, four RCTs and 10 cluster RCTs) of varying quality with risk of bias identified, which used six different types of interventions.…”

Section: Discussionmentioning

confidence: 99%

Primary health care provider–focused interventions for improving outcomes for people with type 2 diabetes: a rapid review

Faruqi

Thomas

Parker

et al. 2019

Public Health Res Pract

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Objectives and importance of the study: The bulk of care for people with type 2 diabetes occurs in primary health care. This rapid review evaluated the effectiveness of primary health care provider-focused interventions in improving biochemical, clinical, psychological and health-related quality-of-life outcomes in people with type 2 diabetes. Methods: We searched Medline, Embase, All EBM Reviews, CINAHL, PsycINFO and grey literature focusing on the Organisation for Economic Cooperation and Development (OECD) member countries. We selected studies that targeted adults with type 2 diabetes, described a providerfocused intervention conducted in primary health care, and included an evaluation component. Four researchers extracted data and each included study was assessed for quality by two researchers. Results: Of the 15 studies identified, there was one systematic review (high quality), four randomised controlled trials (RCTs) (two strong quality, one each moderate and weak) and 10 cluster RCTs (two strong quality, five moderate, three weak). The range of follow-up periods was 3-32 months. In all but one study, the intervention was compared against usual care. The applied interventions included: computerised and noncomputerised decision support; culturally tailored interventions; feedback to the healthcare provider on quality of diabetes care; practice nurse involvement; and integrated primary and specialist care. All interventions aimed to improve the biochemical outcomes of interest; 13 studies also included clinical, psychological and/or health-related quality-of-life outcomes. Outcome results were mixed. Conclusions: All interventions had mixed impacts on the outcomes of interest except the one study testing a decision aid, which did not show any improvement. A number of interventions are already available in

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Does the shortage of diabetes specialists in regional and rural Australia matter? Results from Diabetes MILES—Australia

Cited by 17 publications

References 27 publications

Do the classification of areas and distance matter to the assessment results of achieving the treatment targets among type 2 diabetes patients?

Do the classification of areas and distance matter to the assessment results of achieving the treatment targets among type 2 diabetes patients?

Short‐term intensive insulin therapy at diagnosis in type 2 diabetes: plan for filling the gaps

Primary health care provider–focused interventions for improving outcomes for people with type 2 diabetes: a rapid review

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