Diabetes service ‘effective’ in preventing hospital admissions
Managing people with poorly-controlled type 2 diabetes by general practices is as effective as using intermediate care teams run by specialist teams, researchers have concluded.
A new model of diabetes care provided by GP practices is as effective at keeping people with the condition out of hospital than more expensive services involving specialists from secondary care, according to the study.
Researchers compared eight surgeries in Leicester offering a newer enhanced primary care diabetes service against eight practices served by intermediate specialist-community care diabetes services.
Since diabetes can cause several acute and chronic complications, which could potentially lead to hospitalisations, focusing on reducing the number and/or duration of admissions for people with diabetes has a huge potential for reducing hospital bed use
The study, published in Primary Care Diabetes, aimed to demonstrate that the service provided by the enhanced practices did not lead to an increase in unplanned hospitalisations over and above the specialist alternative referred to as the core service.
Over a 12-month period, a difference of more than one patient out of every hundred adult patients with diabetes occupied a bed overnight in the hospital in the core practices compared the a difference of less than one for patients from the newer enhanced primary care diabetes practices.
The enhanced service involved primary care physicians and nurses with an interest in diabetes who attended monthly diabetes education meetings and provided care plans and audits. The core service involved a multidisciplinary team including specialists from hospital.
This project has been by part-funded by NIHR CLAHRC East Midlands, a partnership of regional health services, universities and industry which turns research into cost-saving and high-quality care through cutting-edge innovation. Support has also been provided by the NIHR Leicester-Loughborough Diet, Lifestyle and Physical Activity Biomedical Research Unit (BRU), a national centre of excellence in diet, lifestyle and physical activity.
Dr Sam Seidu, who led the research and is a Leicester GP and researcher at the Leicester Diabetes Centre, said: “Our analyses indicated that the use of a structured diabetes shared care service redesign is unlikely to increase hospitalisations, outpatients’ attendance or admissions for diabetes-related complications any more than an integrated specialist-community care core diabetes service.
“Since diabetes can cause several acute and chronic complications, which could potentially lead to hospitalisations, focusing on reducing the number and/or duration of admissions for people with diabetes has a huge potential for reducing hospital bed use.
“Emergency admissions resulting from diabetes or its complications are an unexpected health event and could represent poor outcomes or failure to initiate or augment the management of a patient with diabetes at the appropriate time.
“This indicates an inefficient use of healthcare that provides diabetes care closer to home for patients with poor glycaemic control.”
Professor Kamlesh Khunti, professor of primary care diabetes and medicine at the University of Leicester and co-founder of the Leicester Diabetes Centre, added: “Globally diabetes prevalence is increasing and this new enhanced model of care with diabetes being managed in primary care settings is likely to be a more cost-effective.”
The Leicester Diabetes Centre is an international centre of excellence in diabetes research, education and innovation and is led by Professor Khunti and Professor Melanie Davies CBE. Hosted at Leicester General Hospital, it is a partnership between the University Hospitals of Leicester NHS Trust and the University of Leicester.