title: Geography does not limit optimal diabetes care: use of a tertiary centre model of care in an outreach service for type 1 diabetes mellitus.
abstract: OBJECTIVE
  Young people with type 1 diabetes mellitus living in rural and regional Australia have previously been shown to have limited access to specialised diabetes services. The Royal Children's Hospital Melbourne has been running diabetes outreach clinics to Western Victoria, Australia, for over 13 years. We aim to evaluate this service by comparing the outcomes of three outreach clinics with our urban diabetes clinic at the Royal Children's Hospital Melbourne.
  
  
  METHODS
  We examine our tertiary, multidisciplinary team-based model of care, where visiting specialist medical staff work alongside local allied health teams. The local teams provide interim care between clinics utilising the same protocols and treatment practices as the tertiary centre. Longitudinal data encapsulating the years 2005-2010, as a cohort study with a control group, are reviewed.
  
  
  RESULTS
  A total of 69 rural patients were compared with 1387 metropolitan patients. Metabolic control was comparable, with no difference in mean HbA1c (8.3%/67 mmol/mol for both groups). Treatment options varied slightly at diagnosis, while insulin pump usage was comparable between treatment settings (20.3% rural compared with 27.6% urban, P = 0.19). Of note was that the number of visits per year was higher in the rural group (3.3 per year rural compared with 2.7 urban, P < 0.001).
  
  
  CONCLUSIONS
  We conclude that the outreach service is able to provide a comparable level of care when the urban model is translated to a rural setting. This model may be further able to be extrapolated to other geographic areas and also other chronic health conditions of childhood.
authors.affiliation: Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia; Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Simm
authors.forename: Nicole
authors.initials: N
authors.lastname: Wong
authors.forename: Lynne
authors.initials: L
authors.lastname: Fraser
authors.forename: John
authors.initials: J
authors.lastname: Kearney
authors.forename: Judy
authors.initials: J
authors.lastname: Fenton
authors.forename: Kim
authors.initials: K
authors.lastname: Jachno
authors.forename: Fergus J
authors.initials: FJ
authors.lastname: Cameron
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000706:statistics & numerical data; D002648:Child; D003159:Community-Institutional Relations; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D005843:Geography; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006776:Hospitals, Pediatric; D006801:Humans; D007328:Insulin / Q000627:therapeutic use; D007373:Interinstitutional Relations; D008137:Longitudinal Studies; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods*; D009313:National Health Programs / Q000458:organization & administration*; D011787:Quality of Health Care; D018570:Risk Assessment; D012424:Rural Population; D062606:Tertiary Care Centers; D016896:Treatment Outcome; D014505:Urban Population; D014739:Victoria
chemical_list: D007328:Insulin
keywords: HbA1c; outreach; rural