In brief
The greatest opportunities to enhance diabetes care in the Australian primary health care setting seem to be:
- delivering culturally tailored programs involving community health workers (a strong interest of mine)
- incorporating diabetes decision support into practice software.
About the paper
Colleagues at the Centre for Primary Health Care and Equity and I did a rapid review on what works to improve outcomes for people with Type 2 diabetes in primary health care , which is available now.
We identified (1) computerised decision support, (2) feedback and benchmarking on diabetes care quality, (3) culturally tailored programs (usually delivered by community health workers), and (4) enhanced practice nurse involvement in diabetes care as interventions that had a positive impact across several outcome measures. These outcomes included:
- clinical outcomes (blood pressure, and body mass index, or weight)
- biochemical outcomes (glycosylated haemoglobin [HbA1c], lipid profile, or renal function)
- psychological outcomes (anxiety, depression, diabetes-related distress, perceived seriousness and vulnerability, self-efficacy, or self-care)
- health-related quality of life measures from participant self-report.
The evidence about the use of decision aids (e.g. when to commence statins) was equivocal in terms of their impact on HbA1c, lipid profile and renal function. One high quality integrated care study on a virtual clinic, which brought together nurses, diabetologists and GPs, showed improvements in blood pressure but not renal function. No single intervention improved all the outcome measures that were considered.