70-80% of patients with type 2 diabetes (T2D) are managed in primary care in Australia. Patients managed in hospital based outpatients have the advantage of multi-disciplinary team care. They have dietitians, credentialled diabetes educator (CDE), physiotherapists and of course, the endocrinologist in the team. On the other hand, we, as GPs, have the advantage of knowing our patients and their families’ social environment. We can also see them a lot more often. We certainly do the job much cheaper. Does it have to be two separate models? Could we not have a bit of both worlds and have an integrated primary-secondary model. Who does the job better?
A recent scientific trial in Brisbane compared a supported, community based, integrated GP model of care (“the Beacon Model“) with standard hospital based endocrinologist-led outpatient care “integrated care”. The GPs in the community based practice were GPs with special interest in diabetes. They underwent a 23 hour online advanced diabetes course and attended a one day workshop. The Diabetes Nurse Educator (DNE) was specifically skilled in case coordination. Consultations with patients were always done with both the endocrinologist and GPs in the same sitting.
Between Nov 2012 and July 2015, 352 eligible individuals were randomised to either the Beacon model or usual outpatient care. Patients were discharged when they completed the 12 month study protocol or earlier if they have met their clinical targets. The mean age was 55.7 years and the average duration of diabetes was 10 years.
At 12 months, there were no significant difference in glucose targets (HbA1c) between the groups. The proportion of patients reaching clinical targets were also similar between the groups. In other words, GP care is as good as the multi-disciplinary outpatient care in achieving clinical outcomes in patients with diabetes. Patients were more satisfied with their care in the community practices.
The queue to the outpatient for patients with diabetes is long. The queue for a private endocrinologist is equally long (and expensive for many of our patients). The path to improving your skills in diabetes management is simple and convenient. GPs with special interest in diabetes can look after patients with T2D as well as the outpatient and at a fraction of the cost to the system as well as to our patient. It can be very satisfying as a clinician to see patients achieve all their targets.
At healthficus, we has a special interest in diabetes. Our staff are trained in all aspects of diabetes. Our team include a podiatrist, a visiting endocrinologist with special interest in diabetes and a visiting exercise physiologist. We have evidence that we,are a good as a hospital based diabetes centre in achieving results. The “Beacon” model of care requires that GPs with special interest in diabetes. In fact, they need the whole team with special interest in diabetes.
Here, at healthfocus have all the staff on board.