Aim: To describe our recent positive experience in the Hunter region of using case-conference style consultations in General Practices together with Endocrinologist, GP, Diabetes Educator, Practice Nurse and the person with type 2 Diabetes.
Methods: 30 moderate-high risk (based on Joslin risk stratification scores) type 2 diabetes patients per practice were recruited from 18 general practices across the Hunter through an expression of interest. A 40 minute case- conference was conducted addressing lifestyle changes and treatment plans were made. The recommendations were then implemented by the primary care team without any follow-up by specialist team. Baseline, 3 months and 6 months data were collected.
Results: 396 diabetic patients were seen over 14 months, mean age 63.5±11.6yrs; duration of diabetes 11±7yrs, mean HbA1c 62.8±15.9mmol/mol. 50 patients had not seen a dietitian despite BMI>35kg/m2.
92% had medications changes recommended and good holistic general medicine was practised.
At 6 months interim follow-up across 109 patients showed significant improvement in clinical parameters. HbA1c improved from 60.2 ±15.9 to 55.1±12.5mmol/mol (p=0.0006); weight improved from 100.1±20.6 to 98.7±21kg (p=0.02); total cholesterol 4.5±1.2 to 4.4±1.2mmol/l (0=0.04); systolic BP 139±19 to 133±17mmHg (p= 0.0003).
100% of involved clinicians felt the experience was "satisfying or very satisfying".
Patients reported feeling involved, comfortable and supported. As a result, significant improvement in knowledge and confidence in diabetes management using the validated Patient Activation Measure TM (PAM) was observed.
Conclusions: Intensive case-conference style consultations in general practices appears to be highly effective in improving diabetes related outcomes without burdening the specialist teams with endless follow-ups. This innovative model has added benefit of upskilling primary care clinicians with a potential to improve the outcomes for the rest of the diabetic patients in their practice through improved knowledge and skills.
Acknowledgement: All the staff involved in the Hunter Alliance Diabetes project.