A new model of integrated primary-secondary care for complex diabetes in the community: study protocol for a randomised controlled trial.
BACKGROUND
A new model of complex diabetes care is provided by a multidisciplinary team which incorporates general practitioner (GP) Clinical Fellows supported by an Endocrinologist and diabetes educator within a community-based general practice setting. This study evaluates the health and clinical benefits of the new model of care, assesses the acceptability of the model to patients, GPs and other health professionals, and examines the cost-effectiveness of the model.


METHODS
The study is an open, non-inferiority randomised controlled trial with data collected at baseline, 6 and 12 months. Participants are identified from new patients on hospital-based diabetes outpatient clinic waiting lists and new GP referrals. Eligible consenting patients are randomised to either a community practice site (intervention) or a hospital site (usual care). In the intervention model, medical care is led by a GP Clinical Fellow in partnership with an Endocrinologist. Quantitative measures include clinical indicators with HbA1c as the primary outcome; patient-reported outcomes include health-related quality of life, mental health and satisfaction with care. Qualitative methods will be used to explore the perspectives and experiences of patients and providers regarding the new model of care. An economic evaluation will also be undertaken.


CONCLUSIONS
This model of care seeks to improve the quality and safety of healthcare at the interface between the hospital and primary care sectors for patients with complex diabetes. The study will provide empirical evidence about the impact of the model of care on health outcomes, patient and clinician satisfaction, as well as any economic impacts.


BACKGROUND
Clinical Trials Registry Number: ACTRN12612000380897.
School of Medicine, The University of Queensland, Royal Brisbane & Women's Hospitals, Level 8, Health Sciences Building, Building 16/910, Herston Road, Herston, QLD 4006, Australia. jenny.zhang@uq.edu.au.
Jianzhen
J
Zhang
Letitia
L
Burridge
Kimberley A
KA
Baxter
Maria
M
Donald
Michele M
MM
Foster
Samantha A
SA
Hollingworth
Robert S
RS
Ware
Anthony W
AW
Russell
Claire L
CL
Jackson
D015415:Biomarkers / Q000097:blood; D003131:Combined Modality Therapy; D003153:Community Health Services; D019033:Delivery of Health Care, Integrated; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D033183:Interdisciplinary Communication; D010348:Patient Care Team; D017060:Patient Satisfaction; D011320:Primary Health Care; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011788:Quality of Life; D011793:Queensland; D012107:Research Design; D063127:Secondary Health Care; D013997:Time Factors; D016896:Treatment Outcome
D015415:Biomarkers; D006442:Glycated Hemoglobin; C517652:hemoglobin A1c protein, human