title: Evaluation of a community diabetes initiative: Integrating diabetes care.
abstract: OBJECTIVE
  To evaluate the impact of a community diabetes initiative, aiming to improve the efficiency of type 2 diabetes (T2DM) care within the Cardiff and Vale Health Board.
  
  
  METHODS
  In 2012, a community diabetes initiative was introduced in Cardiff and Vale. Ten National Health Service (NHS) consultant diabetologists and three nurse specialists supported 69 general practices in this region. Here we evaluate the impact of this initiative by assessing the number and quality of secondary care diabetes clinic referrals before (2011-2012) and after implementation (2013-2014). Referrals pre and post initiative were audited against Cardiff and Vale T2DM referral guidelines in two 6-month periods.
  
  
  RESULTS
  In the 6-months prior to the initiative, 108 referrals were received, 78 of which were in line with local guidance. Approximately one year after embarking on the diabetes initiative (2013-2014) there was a 31% reduction (p<0.01) in the total number of T2DM clinic referrals and a 57% reduction (p<0.01) in referrals outside the guidelines. A decrease in referrals was not seen in the practice noted not to engage with the initiative.
  
  
  CONCLUSIONS
  The community diabetes initiative intervention has significantly improved the appropriateness of T2DM referrals from GP practices engaged with the initiative. As a result we advocate a move towards integrated diabetes care within the community.
authors.affiliation: University Hospital of Wales, Cardiff, UK.
authors.forename: Jason Leo
authors.initials: JL
authors.lastname: Walsh
authors.affiliation: University Hospital of Wales, Cardiff, UK. Electronic address: bhlharris@gmail.com.
authors.forename: Benjamin Howell Lole
authors.initials: BH
authors.lastname: Harris
authors.affiliation: University Hospital of Wales, Cardiff, UK. Electronic address: aled.roberts2@wales.nhs.uk.
authors.forename: Aled Wyn
authors.initials: AW
authors.lastname: Roberts
mesh_terms: D003153:Community Health Services / Q000458:organization & administration* / Q000592:standards; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration* / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000628:therapy*; D058006:General Practice / Q000458:organization & administration; D019983:Guideline Adherence; D006801:Humans; D008485:Medical Audit; D009722:Nurse Practitioners / Q000458:organization & administration; D010348:Patient Care Team / Q000458:organization & administration* / Q000592:standards; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D015397:Program Evaluation; D012017:Referral and Consultation / Q000458:organization & administration; D013222:State Medicine / Q000458:organization & administration* / Q000592:standards; D013997:Time Factors; D014852:Wales
keywords: Community; Diabetes; E-mail; Primary care; Referral; Secondary care; Service-based research; Specialist nurse