Building general practice capacity to enhance diabetes care in the community via case conferencing: early findings from Western Sydney Local Health District. — ASN Events
  1. Schedule
  2. ADS Clinical Poster Viewing: Diabetes Care
  3. Building general practice capacity to enhance diabetes care in the community via case conferencing: early findings from Western Sydney Local Health District.

Building general practice capacity to enhance diabetes care in the community via case conferencing: early findings from Western Sydney Local Health District. (#352)

Mani Manoharan 1 , Sian Bramwell 1 , Glen Maberly 1 , Mark Mclean 1
  1. Black town Hospital, Girraween, NSW, Australia

Introduction: The rising burden of diabetes is driving a‘whole of district’ approach to enhance diabetes prevention and management in the Western Sydney Local Health District. To promote better diabetes care in the community, members of the Blacktown Hospital Diabetes Clinic staff including hospital Diabetologist, senior endocrine registrar, resident medical officer, and a Credentialled diabetes educator conducted case conferences in general practice settings as part of the Western Sydney Diabetes Prevention and Management Initiative in 2014.

Objectives: (1)Toexamine trends in key biomarkers of diabetes before and after the introduction of case conferencing.(2) To assess the degree of satisfaction with the case conferencing program among general practitioners.

Methodology:Case conferences with patients and their general practinioners(GP) were arranged by WSML at general practices that volunteered for the program. Patients with a range of complexity were selected by the GPs and referred to the Specialist team. Genie Solutions software was used to record patient data and to generate report following the case conferences. Biomarker and general practitioner satisfaction data were collected across 11 months from 41 patients managed by 19 general practitioners. Multilevel linear regression was used to analyse the biomarker data including HbA1C, weight, blood pressure and lipid profile.

Results: At follow-up 3-6 months after the initial case conference, reductions in HbA1c concentration (-0.87% (95%CI -1.31, -0.44)), weight (-1.90kg (95%CI -4.56, 0.75)), and systolic blood pressure (-6.45mmHg (95%CI -11.48, -1.41)) were observed. We also noted reductions in diastolic blood pressure (-3.93mmHg (95%CI -7.60, -0.27)), total cholesterol (-0.46, 95%CI -0.76, 0.17), triglycerides (-0.32, 95%CI -0.68, 0.05), and  increase in high density lipoprotein (0.09, 95%CI 0.03, 0.151).Approximately85% of GPs strongly agreed case conferences helped to decrease referrals to specialist outpatient clinics, while 95% reported interactive sessions increased their confidence in managing complex patients and would recommend this program to colleagues.

Conclusion: These findings indicate the potential effectiveness of case conferences to enhance diabetes care in the community and to help improve relationships between general practitioners and diabetes specialists. The program is aimed at building GPs ability to manage diabetes and not as an alternative model of care. Based on this experience the program is expanding.

  1. Physician in practice clinic: educating Gps in endocrinology through specialist-outreach. JMoffat, D Hossain, G Hansford. Rural and Remote Health 12:2265.2012.
  2. Model of care for the management os complex diabetes managed in the community by primary care physicians with specialist support:an open controlled trial, A.W. Russell et al;Diabet,Med.30,1112-1121 (2013)