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Better education, specialist access and care coordination with primary health-care is required to improve health-care for diabetes and chronic kidney disease (#317)

Clement Lo 1 2 , Helena Teede 1 2 , Grant Russell 3 , Timothy Usherwood 4 , Greg Fulcher 5 , Martin Gallagher 6 7 , Peter Kerr , Kevan Polkinghorne 8 , Rowan Walker 9 , Sophia Zoungas 1 2 6
  1. Diabetes and Vascular Research Program, Monash Centre for Health Research and Implementation, Monash University, Melbourne, Victoria, Australia
  2. Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Victoria, Australia
  3. School of Primary Health Care, Monash University, Melbourne, Victoria, Australia
  4. Department of General Practice, Westmead Clinical School, University of Sydney, Sydney, New South Wales, Australia
  5. Department of Diabetes and Endocrinology, The Royal North Shore Hospital, Sydney, New South Wales, Australia
  6. The George Institute of Global Health, Sydney, New South Wales, Australia
  7. Concord Clincial School, University of Sydney, Sydney, New South Wales, Australia
  8. Department of Nephrology, Monash Health, Melbourne, Victoria, Australia
  9. Department of Renal Medicine, Alfred Health, Melbourne, Victoria, Australia

Although diabetes and chronic kidney disease (CKD) is associated with increased mortality, and morbidity, the relevant health-care can be suboptimal.  In this mixed-methods cross-sectional study we explored general practitioners (GPs) perspectives on the management of diabetes and CKD, including access to and coordination of care with specialist services.

A survey exploring key barriers to managing diabetes and CKD was widely disseminated via email/ mail to 840 GPs referring patients to 4 major health-services in Melbourne and Sydney (3:1 ratio).  Survey questions were derived from analysis of focus groups undertaken with GPs in the catchment areas of each health-service.  Descriptive statistics were performed (STATA v2.1).

Responses were received from 115 GPs; mean (+/-SD) age 55 (10) years, mean duration of practice 27 years, and working a mean 32 (12) hours/ week. The median number of GPs in each participating  GP’s practice was 8 (5-11).    The majority (88%) wanted to manage diabetes and CKD in primary care with specialist assistance.   However, one in three  (35) of respondents were unclear about the definition of CKD with 80% wanting more education about prevention of CKD in diabetes.  20% and 27% reported difficulty deciding when to refer to diabetes and CKD specialist services respectively.  Coordination of care was a problem.  One third ( 36%) of participants were unclear about the role of each health provider.  51% believed  patients faced difficulties due to poor coordination across providers, and 52% reported that  tests were duplicated because results were unavailable.  Access to specialist services was problematic with 48% and 43% reporting that diabetes and CKD services were difficult to refer to and 45% and 35% reporting difficulty obtaining management advice from diabetes and CKD services, respectively. 

Education on the definition and prevention of CKD and indications for specialist referrals, improved access to specialist services, and improved coordination of care between health providers, is required to supports GPs in providing better health-care for diabetes and CKD.