Effectiveness of joint specialist case conferences for building general practice capacity to enhance diabetes care

Abstract

Purpose Type 2 diabetes mellitus has become a major concern of Australian healthcare providers. From rates of barely more than 1 percent in the mid-90s, diabetes is now the leading cause of morbidity in the country. To combat the growing diabetes epidemic, Western Sydney Local Health District created the Western Sydney Diabetes (WSD) initiative. One of the key components of the WSD initiative since 2014 has been joint specialist case conferencing (JSCC). The purpose of this paper is to evaluate the JSCC service including both individual- and practice-based changes. Design/methodology/approach The authors evaluated the JSCC program by conducting an analysis of patient-level data in addition to a discrete practice-level study. The study aim was to examine both the effect on individual patients and the practice, as well as acceptability of the program for both doctors and their patients. The evaluation included data collection and analysis of primary patient outcomes, as well as a survey of GPs and patients. Patient data on primary outcomes were obtained by accessing and downloading them through GP practice management software by GP practice staff. Findings The authors found significant improvements at both the patient levels, with reductions in BMI, HbA1c and blood pressure sustained at three years, and at the practice level with improvements in markers of patient management. The authors also found high acceptability of the program from both patients and GPs. Originality/value This paper provides good evidence for the use of a JSCC program to improve diabetes management in primary care through capacity building with GPs.

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“…Joint Specialist Case Conferencing comprises of an integrated discussion about a patients’ diabetes management between the diabetes specialist, resident, diabetes educator, patient and primary care physician and is carried out in the primary care clinic for 30-min consultations per patient. We have previously shown that JSCC lead to benefits after a single visit to primary care physicians, including an absolute reduction of − 0.87% in HbA1c and reductions in blood pressure, lipid profile and weight, and that the results were durable to 3-years [21].…”

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“…In western Sydney, successful Integrated Care initiatives have been progressively incorporated into today’s co‐commissioning models of care. These include: specialist rapid access clinics for patient stabilisation and general practitioner support, demonstrating a 32% reduction in emergency department presentations and a 34% reduction in admissions; 11 diabetes outreach to general practice via specialist case conferencing, demonstrating enhancement in general practice team capability and patient clinical outcomes; 12 and non‐prescribing pharmacists in general practices providing measurable change or deprescribing in complex care patients 13 …”

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

“…Cases discussed were those with significant hyperglycaemia (HbA1c ≥9%, 75 mmol/mol), uncertain diagnoses, wider metabolic issues and where next management steps were uncertain. The "patientfree" approach has previously been used in England [16] and it differs from the patient present approach used elsewhere [17]. HealthPathways is an online referral guidelines portal used by health professionals at the point of care to plan patient care, and where necessary, provide information on how to refer to specialists and other services [18].…”

“…Joint specialist and general practitioner case conference evaluations in Western Sydney and Hunter and New England have been associated with improvements in clinical parameters such as Haemoglobin A1c, Body Mass Index and blood pressure of patients. They have high program acceptability from both general practitioners and patients [17,31]. Such Australian integrated diabetes care approaches, along with the Beacon model (diabetes care within general practice supported by an endocrinologist, credentialed diabetes educator and delivered by advanced skill general practitioners) show that better glycaemic control is achievable through a more integrated approach between general practitioners and specialist care [32].…”