1304-P: “They Were All Together...Discussing the Best Options For Me”: Integrating Specialist Diabetes Care within Primary Care

Introduction: In Australia, over a third of encounters with health care providers for diabetic patients fail to provide clinical guideline appropriate care. The Diabetes Alliance, integrated care model implemented across a large healthcare district with a view to enhance diabetes care capacity at primary care through intensive case-conferencing with primary care team, patients and visiting specialist team; whole practice performance feedback, and; regular diabetes masterclasses. Here, we aimed to provide in-depth insight into the case-conferencing process and impact of the model of care for patients with diabetes.

Methods: Patients from 5 practices (including 2 with high and 3 with low proportions of patients with a recent HbA1c) provided the sampling frame. Patients were selected according to Patient Activation Measure scores to achieve maximum variation with 1 or 2 patients with high scores and 2 or 3 patients with low scores were selected from each practice. Participants were sampled until saturation was achieved. Thematic content analysis was applied to the 19 interviews.

Results: Patients largely found the model of care a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition), with the program providing an opportunity to refocus when “life gets in the way.” Other key aspects of the program that were viewed positively included the holistic approach to healthcare, reduced travel time and congestion, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Patients however also described difficulties in coping with diabetes as a chronic illness and adherence to treatment recommendations.

Conclusion: Providing timely integrated specialist care within the primary care setting is an efficient means of enhancing the engagement of diabetic patients with their diabetes care and therefore their outcomes.