Poster Presentation Australian Diabetes Society and the Australian Diabetes Educators Association Annual Scientific Meeting 2017

Enhanced management of type 2 diabetes in the primary care setting: The WA Complex Care Collaboration in Diabetes project (#247)

Michelle M England 1 , Jocelyn J Drinkwater 1 , P. Gerry Fegan 2 , Krishnamurthy Chikkaveerappa 2 , Wendy A Davis 1 , Timothy M E Davis 1
  1. School of Medicine, University of Western Australia, Perth, Western Australia, Australia
  2. Endocrinology Department, Fiona Stanley Hospital, Perth, Western Australia, Australia

Diabetes outpatient clinics have long waiting lists, especially for non-urgent referrals, and delays in accessing specialist care can have adverse outcomes. To address these issues, a Brisbane-based intervention has used upskilled general practitioners (GPs) to manage GP-referred complex type 2 diabetes cases in the community, with support from an onsite endocrinologist and diabetes educator (1). This model of care improved clinical outcomes including HbA1c, blood pressure and serum LDL cholesterol (1). The model was adapted to suit the West Australian Health system and assessed through the Collaborative Complex Care in Diabetes Project (DCCC).  The DCCC differs from the Brisbane model in that i) it is delivered as ‘usual care’ and not as part of a research programme, and ii) visits to upskilled GPs are limited to a maximum of two per patient, with a continuing management plan developed for the referring GP. De-identified data collected as part of usual care are available for all participants. Further prospective data are being collected from consenting participants including health care utilisation (emergency attendances and hospitalisations), lifestyle changes, management changes and incident complications. Evaluated participants (currently n=92) had a mean±SD age of 60.6±13.0 years at DCCC entry and 47.8% were male. Median [IQR] diabetes duration was 8.6 [1.1-20.7] years (n=31). Although follow-up data are incomplete, there were significant decreases in HbA1c, waist circumference, supine blood pressure and BMI between the initial DCCC visit and follow up for a subgroup (see table). The Fremantle Hospital diabetes outpatient waiting list decreased by 32% from 763 in February 2016 to 517 in February 2017. Data collection is continuing and will inform updated analyses. 

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These unadjusted preliminary results shows that the DCCC is a promising intervention that improves diabetes care and reduces outpatient waiting times.

 

  1. Russell AW, Baxter KA, Askew DA, Tsai J, Ware RS, Jackson CL. Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial. Diabetic Medicine. 2013;30(9):1112-21.