Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years

Abstract

Structured primary care led to improvements in the quality of care over time. Poorer recording of some processes, a decline in annual review attendance, and participants remaining at high risk suggest limits to what structured care alone can achieve. Engagement in continuous quality improvement to target other factors, including attendance and self-management, may deliver further improvements.

Multidisciplinary Approach to Management and Care of Patients with Type 2 Diabetes Mellitus

“…The MDT approach should be focussed on integrated management with multiple treatment goals including glucose, blood pressure and lipid control, life style management, regular appointments, and screening for the prevention of T2DM morbidities. 39,40 For those patients who are considered to have less complex clinical needs, integrated care with MDT should be anchored in the primary care setting. 41,42 This structure has led to cost savings and a reduction of disease burden for healthcare systems related to fewer hospitalisations and vascular events.…”

“…43 Whilst primary care physicians (PCP) are the first point of contact and a source of continuous comprehensive care, they do not work in isolation but involve other specialities, such as podiatrists, nurses, and dietitians. 39 Patients with complex needs and high rates of morbidities are referred to endocrinologists and are typically seen in hospital outpatient settings. 41 Optimal diabetes interdisciplinary care of these patients is complex and the number of HCP involved rises due to the need to prevent and manage multi-morbidities such as CKD and heart failure.…”

“…The hospital-based team may include ophthalmologists, cardiologists, nephrologists, a diabetic foot team, and the PCP. 39,40,44,45 The principles, key concepts, and core components for multidisciplinary care are displayed in Figure 1. All the MDT team members need to be actively involved to ensure an effective approach to the provision of care.…”

“…Further to the MDT, optimal diabetes management programmes also include different components such as registration systems, 39 audit and feedback, clinician reminders, patient and HCP education, and IT systems.…”

“…59,60 Despite the evidence that suggests MDT improves patient outcomes and is cost effective, there is some doubt if the processes used in studies can be effectively replicated in 'real-world' situations due to economic pressures on primary care and the large number of patients with T2DM. 39,50,56 Furthermore, most studies assessing MDT approaches have limited study periods compared with the time that MDT need to be in place in real-world clinical practice. This hypothesis was tested in a study that assessed the quality of care provided by the Health and Safety Executive Midlands Diabetes, Structured Care Programme that was established in 1997 in Ireland.…”