THE DIABETES CARE PROJECT: A CLUSTER RANDOMISED TRIAL OF CARE FACILITATION AND STRUCTURED CLINICAL QUALITY IMPROVEMENT IN GENERAL PRACTICE IN 3 AUSTRALIAN STATES: BASELINE CLINICAL INDICATORS — ASN Events

THE DIABETES CARE PROJECT: A CLUSTER RANDOMISED TRIAL OF CARE FACILITATION AND STRUCTURED CLINICAL QUALITY IMPROVEMENT IN GENERAL PRACTICE IN 3 AUSTRALIAN STATES: BASELINE CLINICAL INDICATORS (#100)

Robyn McDermott 1 2 , Tim Fountaine 3 , Kevin Cheng 3 , Adrian Esterman 1 , Derek Brand 3 , Ming Li 1 , Karen Allison 3
  1. Division of Health Sciences, University of South Australia, Adelaide, SA, Australia
  2. School of Public Health, James Cook University, Cairns, Qld, Australia
  3. McKinsey Ltd, Sydney, NSW, Australia

 

Background: Diabetes, especially T2DM fuelled by increasing rates of obesity, affects over 7% of Australian adults and is increasing at 0.75% per year (1). It is complex and costly to manage and the limited published data suggest that less than half those with diabetes are achieving clinical control targets. Aim: To evaluate the impact of electronically enabled care planning, a CQI cycle and dedicated care facilitation on patient experiences, service uptake, clinical outcomes and cost of care. Study design: Cluster RCT in General Practices in SA, Victoria and Queensland randomized to 3 arms of 50 practices and approximately 2,500 patients with diabetes each: Control (usual care), Intervention group 1 (care planning tool, CQI support) and Intervention Group 2 (care planning tool, CQI, Care Facilitator for every 5 practices, risk-based funding and GP clinical outcome incentives) over a 12 month period. Main Outcome Measures: AQoL-4D, PAID, PHQ-9, PEQD, HbA1c, BP, BMI, Lipids, uptake of Care Plans (GPMP, TCA). Baseline Clinical Results: The target practices (n=150) and patients (n=7,500) were enrolled with 15% of practices withdrawn from the study, spread evenly across the 3 arms. The mean age (65.7 years) and sex (66% males) of participants is similar to a national sample who reported having diabetes in the last National Health Survey, mean BMI is higher among women (33.0) than men (31.2), 10.6% are smokers, 52% have well controlled glycemia (HbA1c<7%) and 13.6% are poorly controlled (HbA1c>8.5). A high proportion (21% overall, and one third of the poorly controlled group) report moderate to severe depression on PHQ-9. Conclusions: In this sample of adults with diabetes in general practice, more than half are achieving target glycemia, however a significant proportion report depression associated with poor control. Managing depression, including increasing physical activity, may improve clinical outcomes in this group.

  1. 1. Magliano DJ, Barr ELM, Zimmet PZ, Cameron AJ, Dunstan DW, Colagiuri S, et al. Glucose Indices, Health Behaviors, and Incidence of Diabetes in Australia: The Australian Diabetes, Obesity and Lifestyle Study. Diabetes Care. 2008;31(2):267-72.
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