Bundled payment of diabetes care: first steps towards integrated care

The COVID-19 pandemic has profoundly changed people's habits and social organization, including the care models of people with chronic diseases. Diabetes care in Ferrara is based on Integrated Care Protocols (ICP) in collaboration with General Practitioners (GPs). The sudden arrival of the Covid-19 pandemic has resulted in the suspension of most of the planned health activities. The Diabetes Services have mainly dedicated themselves to communicating by telephone with their clients to suspend appointments and monitor their health conditions, accepting only urgent situations that could not be managed by telephone. The psychosocial aspects of people with diabetes have led to the fear of contagion taking into account the greater risks related to age and comorbidity and the aspects of loneliness and reduction of social contacts. After the lockdown, the health systems are reactivating the suspended treatment paths even if with all the measures to avoid spreading the infection. Consequently, the assistance activities will be quantitatively less numerous to apply the safety criteria. E-health gives the opportunity to customize monitoring and assistance and to configure a profile of the monitored parameters aimed at revaluations of care in the clinic only when necessary, rather than at predetermined deadlines.

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Process evaluation of integrated diabetes management at primary healthcare facilities in Pakistan: a mixed-methods study

BJGP Open ◽

10.3399/bjgpopen18x101612 ◽

2018 ◽

Vol 2 (4) ◽

pp. bjgpopen18X101612 ◽

Cited By ~ 4

Author(s):

Muhammad Amir Khan ◽

John D Walley ◽

Saima Ali ◽

Rebecca King ◽

Shaheer Ellahi Khan ◽

...

Keyword(s):

Integrated Care ◽

Process Evaluation ◽

Diabetes Care ◽

Service Providers ◽

Health Facilities ◽

Care Providers ◽

Phone Calls ◽

Healthy Activity ◽

Clinical Records

BackgroundIntegrated care for diabetes and associated conditions at primary level health facilities can make care available to a much larger population, especially in rural areas.AimThis process evaluation was to understand how the authors' integrated care was implemented and experienced by the care providers and patients, and to inform modifications prior to province-wide scale-up.Design & settingThe mixed-method study was conducted as part of a cluster randomised trial on integrated diabetes care at 14 public health facilities.MethodThe care practices were assessed by analysing the routine clinical records of 495 registered patients with diabetes. Then semi-structured interviews with service providers and patients were used to understand their respective care experiences. A framework approach was applied to analyse and interpret the qualitative data.ResultsThe intervention and the study were implemented as intended under routine conditions in rural health centres. Key service processes effectively delivered included: skill-based training; screening and diagnostic tests; treatment card records; and the additional case management as per desk guide, including monitoring progress in glucose and weight at follow-up consultations, and mobile phone calls to help adherence. However, social and cultural factors affected clients' ability to change lifestyles, especially for women. The intervention effect was limited by the short study follow-up of only 9 months.ConclusionIntegrated diabetes care was feasible, both for providers and patients, and potentially scalable at primary care facilities under routine conditions in Pakistan. Additional operational interventions are required for sustained drug supplies, supervision, in-service training, and to address the social challenges to healthy activity and eating, especially for women.

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Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan

BMC Family Practice ◽

10.1186/s12875-020-01284-w ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Jerry Che-Jui Chang ◽

Shinn-Jang Hwang ◽

Tzeng-Ji Chen ◽

Tai-Yuan Chiu ◽

Hsiao-Yu Yang ◽

...

Keyword(s):

Integrated Care ◽

Family Practice ◽

Diabetes Care ◽

Conditional Logistic Regression ◽

Density Lipoprotein ◽

Fiscal Year ◽

Diabetic Patients ◽

Care Project ◽

Quality Of Diabetes Care

Abstract Background The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care. Methods This population-based cohort study used Taiwan’s National Health Insurance Administration data on FPICP (fiscal year 2015–2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE). Results The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE. Conclusion Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.

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Building the evidence for integrated care for type 2 diabetes: a pilot study

Australian Journal of Primary Health ◽

10.1071/py15020 ◽

2016 ◽

Vol 22 (5) ◽

pp. 409 ◽

Cited By ~ 2

Author(s):

Jessica L. Browne ◽

Jane Speight ◽

Carina Martin ◽

Christopher Gilfillan

Keyword(s):

Type 2 Diabetes ◽

Integrated Care ◽

Diabetes Care ◽

Controlled Trial ◽

Care Model ◽

Service Setting ◽

Quality Of Diabetes Care ◽

The Impact

Integrated care models have the potential to reduce fragmentation in the health system and improve outcomes for people with type 2 diabetes. A pilot evaluation of an integrated care model for people with type 2 diabetes in Melbourne, Australia, is reported on. Two studies were conducted: (1) a 6-month pilot randomised controlled trial (n=56) evaluating the impact of the integrated care model relative to hospital outpatient clinics; and (2) a cross-sectional study (n=92) of patients attending the two services. The primary outcome was diabetes-specific distress; secondary outcomes were perceived quality of diabetes care, diabetes-specific self-efficacy and glycated haemoglobin (HbA1c). There was no effect of service setting on diabetes-specific distress. Participants from the integrated care setting perceived the quality of diabetes care to be higher than did participants from the hospital clinics. Significant HbA1c improvements were observed over time, but with no effect of service setting. The model holds promise for people with type 2 diabetes who need more specialist/multidisciplinary care than can be provided in primary care. Patients’ evaluations of the quality of diabetes care received at the integrated care service are very positive, which is likely to be one of the key strengths of the integrated model.

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