Management of diabetes in primary care: A structured-care approach

Brennan, Carmel; Harkins, Velma; Perry, Ivan J.

doi:10.1080/13814780802689154

Cited by 20 publications

(20 citation statements)

References 11 publications

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“…Those who are not eligible must pay to attend the GP. In terms of diabetes care, at present there are a variety of care arrangements in place across the country including traditional hospital-based management, shared care between general practitioners (GPs) and hospitals, primary care-led management 8 9 and unstructured opportunistic care. The most recent survey of diabetes management in general practice highlighted the lack of formal integration between settings 10.…”

Section: Introductionmentioning

confidence: 99%

Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

et al. 2013

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ObjectiveTo examine the barriers to, and facilitators in, improving diabetes management from the general practice perspective, in advance of the implementation of an integrated model of care in Ireland.DesignQualitative using semistructured interviews.SettingPrimary care in the Republic of Ireland.ParticipantsPurposive sample of 29 general practitioners (GPs) and two practice nurses.MethodsData were analysed using a framework approach.ResultsThe main barriers and facilitators occurred at the level of the health system but had a ripple effect at an organisational, professional and patient level. The lack of targeted remuneration for diabetes management in the Irish health system created apathy in general practice and was perceived to be indicative of the lack of value placed on chronic disease management in the health system. There were ‘pockets of interest’ among GPs motivated by ‘vocational’ incentives such as a sense of professional duty; however, this was not sufficient to drive widespread improvement. The hospital service was seen as an essential support for primary care management, although some participants referred to emerging tension between settings. The lack of coordination at the primary–secondary interface resulted in avoidable duplication and an ‘in the meantime’ period of uncertainty around when patients would be called or recalled by specialist services. Facilitators included the availability of nursing support and serendipitous access to services. The lack of resources in the community was considered to be at odds with policy to shift routine management to general practice, which is fast reaching saturation.ConclusionsAt present, intrinsic motivation is driving the improvement of diabetes care in Ireland. This will not be sufficient to implement the proposed reform including a national model of integrated care. Policymakers need to assess and prepare for the disparate levels of interest and infrastructure in primary care in Ireland to support this change.

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Section: Introductionmentioning

confidence: 99%

Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

et al. 2013

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“…Treating T2DM in the primary care setting has demonstrated effectiveness comparable to diabetes treatment in a specialist setting, such as endicrinology. 52 Indeed, in a recent study of greater than 17,000 subjects, no difference in glycemic control after insulin initiation was seen between primary versus specialist care. 53 However, the management of patients with diabetes and concomitant mental health conditions in primary care is fragmented, when diabetes is managed by the primary care doctor and mental health interventions are delivered by behavioral health providers (BHPs) outside the primary care office.…”

Section: Introduction Disparitiesmentioning

confidence: 99%

“…51 Another study highlights the complex and reciprocal nature of this relationship, demonstrating that elevated anxiety was associated with subsequent poor self-care, and poor self-care was associated with subsequent elevated anxiety, after controlling for depressive symptoms as a covariate. 52 In summary, several theories attempt to describe the relationship between anxiety and diabetes; some suggest that the emotional impact of a diabetes diagnosis, compounded with the burden of daily diabetes management, can lead to anxiety, while others propose that anxiety leads to, or exacerbates, T2DM through physiological mechanisms. Regardless of the direction or source of the relationship, the literature supports the importance of addressing both conditions simultaneously, as one condition cannot be treated in isolation from the other.…”

Section: Introduction Disparitiesmentioning

confidence: 99%

Anxiety and diabetes: Innovative approaches to management in primary care

Bickett

Tapp

2016

Exp Biol Med (Maywood)

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Type 2 diabetes mellitus is a chief concern for patients, healthcare providers, and health care systems in America, and around the globe. Individuals with type 2 diabetes mellitus exhibit clinical and subclinical symptoms of anxiety more frequently than people without diabetes. Anxiety is traditionally associated with poor metabolic outcomes and increased medical complications among those with type 2 diabetes mellitus. Collaborative care models have been utilized in the multidisciplinary treatment of mental health problems and chronic disease, and have demonstrated success in managing the pathology of depression which often accompanies diabetes. However, no specific treatment model has been published that links the treatment of anxiety to the treatment of type 2 diabetes mellitus. Given the success of collaborative care models in treating depression associated with diabetes, and anxiety unrelated to chronic disease, it is possible that the collaborative care treatment of primary care patients who suffer from both anxiety and diabetes could be met with the same success. The key issue is determining how to implement and sustain these models in practice. This review summarizes the proposed link between anxiety and diabetes, and offers an innovative and evidence-based collaborative care model for anxiety and diabetes in primary care.

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“…In Spain, for example, primary care centres, which are similar to those participating in the present study, demonstrated significant improvements between 1993 and 2007 in process measures (such as measurement of HbA1c and lipid levels), intermediate outcome measures [including the proportion of patients with HbA1c ≤7.0% (53 mmol/mol), total cholesterol ≤ 200 mg/dl and blood pressure ≤ 140/90 mmHg], and microvascular complications 27, 28. Primary care–led structured care, with relatively limited but well‐focussed investment, can achieve quality of care for patients with diabetes, comparable to international best practice 7. The organisation of primary care service provision for diabetes continues to evolve.…”

Section: Discussionmentioning

confidence: 99%

Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations

et al. 2016

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SummaryObjectiveTo investigate the effect of healthcare provider (HCP) type (primary vs. specialist) on glycaemic control and other treatment parameters.Research design and methodsStudy of Once‐Daily Levemir (SOLVE ™) is an international, 24‐week, observational study of insulin initiation in people with type 2 diabetes.ResultsA total of 17,374 subjects were included, comprising 4144 (23.9%) primary care subjects. Glycaemic control improved in both HCP groups from baseline to final visit [glycated haemoglobin (HbA1c) −1.2 ± 1.4% (−13.1 ± 15.3 mmol/mol) and −1.3 ± 1.6% (−14.2 ± 17.5 mmol/mol), respectively]. After adjustment for known confounders, there was no statistically significant effect of HCP group on final HbA1c [−0.04%, 95% confidence interval (CI) −0.09 to −0.01 (−0.4 mmol/mol, 95% CI −1.0−0.1 mmol/mol), p = 0.1590]. However, insulin doses at the final visit were higher in primary care patients (+0.06, 95% CI 0.06–0.07 U/kg, p < 0.0001). Logistic regression demonstrated a significant effect of HCP type (primary vs. specialist care) on hypoglycaemia risk [odds ratio (OR) 0.75, 95% CI 0.64–0.87, p = 0.0002]. Primary care physicians took more time to train patients and had more frequent contact with patients than specialists (both p < 0.0001).ConclusionsPrimary care physicians and specialists achieved comparable improvements in glycaemic control following insulin initiation.

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Management of diabetes in primary care: A structured-care approach

Abstract: Primary-care-led structured care, with relatively limited but well-focused investment, can achieve quality of care for patients with diabetes, comparable to international best practice.

Cited by 20 publications

References 11 publications

Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

Anxiety and diabetes: Innovative approaches to management in primary care

Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations

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