Sharing the care of diabetic patients between hospital and general practitioners: does it work?
A randomized controlled trial was conducted to compare three forms of diabetes follow-up: (1) general practitioner care, (2) a system of care shared between the general practitioner (GP) and clinic and (3) conventional clinic care. Two hundred and six diabetic patients without significant diabetes-related or other medical complications were randomized to one of these follow-up systems. Metabolic control and blood pressure improved significantly and equally in all three groups (p < 0.05). The shared care group performed as well as or better than either of the other two groups in all other outcome measures. In particular, final attendance rates were 72% for shared care compared with only 35% for GP care and 53% for clinic care. Data collection rates for shared care were comparable with the clinic group for random blood glucose (88.9% vs 95.1%), weight (93.5% vs 98.3%), and blood pressure (94.8% vs 92.7%). Only in the case of glycosylated haemoglobin did shared care have poorer data collection (66.0% vs 98.4%). In all these parameters, except blood pressure, shared care out-performed the GP group. We conclude that with adequate support from and communication with hospital-based diabetes services, GPs are capable of providing care appropriate to the needs of uncomplicated diabetic patients.
Hoskins
P L
PL
Diabetes Centre, Royal Prince Alfred Hospital, N.S.W., Australia.
Fowler
P M
PM
Constantino
M
M
Forrest
J
J
Yue
D K
DK
Turtle
J R
JR
D001794:Blood Pressure; D001835:Body Weight; D003920:Diabetes Mellitus / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005194:Family Practice; D006442:Glycated Hemoglobin / Q000032:analysis; D006784:Hospitals, Teaching; D006801:Humans; D008875:Middle Aged; D009517:New South Wales; D010044:Outpatient Clinics, Hospital; D010353:Patient Education as Topic; D016896:Treatment Outcome
D006442:Glycated Hemoglobin