title: Evaluating the impact of an enhanced primary care diabetes service on diabetes outcomes: A before-after study.
abstract: Diabetes is an ambulatory care-sensitive condition and a high quality primary care or risk factor control can lead to a decrease in the risk of non-elective hospitalisations while ensuring continuity of care with usual primary care teams.
  
  
  
  In this before and after study, eight primary care practices providing a newer enhanced diabetes model of care in Leicester UK, were compared with matched neighbouring practices with comparable demographic features providing a more expensive integrated specialist-community care diabetes service. The primary outcome at twelve months was to demonstrate equivalence in non-elective bed days. The enhanced practices had primary care physicians and nurses with an interest in diabetes who attended monthly diabetes education meetings and provided care plans and audits. The control practices provided an integrated primary-specialist care service.
  
  
  
  The difference between the mean change in the non-elective bed days from baseline and at follow up in core and enhanced practices was not statistically significant (mean=2.20 per 100 patients, 95% CI=-0.92 to 5.31 per 100 patients, p=0.14). The analogous change for first outpatients' attendance were 0.23 per 100 patients (95% CI=-0.47 to 0.52 per 100 patients p=0.92) and for diabetes related complications admissions was 0.30 per 100 patients (95% CI=-0.85 to 1.45 per 100 patients p=0.55).
  
  
  
  A model of enhanced primary care based diabetes care appears unlikely to increase hospitalisations, outpatients' attendance or admissions for diabetes related complications.
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK. Electronic address: sis11@le.ac.uk.
authors.forename: S
authors.initials: S
authors.lastname: Seidu
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: D H
authors.initials: DH
authors.lastname: Bodicoat
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: M J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: H
authors.initials: H
authors.lastname: Daly
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: B
authors.initials: B
authors.lastname: Stribling
authors.affiliation: NHS Leicester City Clinical Commissioning Group, St. Johns House, 30 East Street Leicester Leicestershire LE1 6NB, UK.
authors.forename: A
authors.initials: A
authors.lastname: Farooqi
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: E M
authors.initials: EM
authors.lastname: Brady
authors.affiliation: Leicester Diabetes Centre, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK; Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4WP, UK.
authors.forename: K
authors.initials: K
authors.lastname: Khunti
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D003153:Community Health Services / Q000458:organization & administration*; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D004739:England; D005260:Female; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D010348:Patient Care Team / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration*; D017064:Process Assessment, Health Care; D015397:Program Evaluation; D012959:Socioeconomic Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Diabetes; Health care professional; Models of care; Non-elective bed days; Primary Care