John S Furler1, Irene D Blackberry2, Christine Walker3, Jo-Anne Manski-Nankervis2, Jenny Anderson2, David O'Neal4, Doris Young2, James Best5. 1. Department of General Practice, University of Melbourne, j.furler@unimelb.edu.au. 2. Department of General Practice, University of Melbourne. 3. Chronic Illness Alliance. 4. Department of Medicine, St Vincent's Hospital and. 5. Department of Medicine, St Vincent's Hospital and School of Medicine, University of Melbourne, Melbourne, Australia.
Abstract
BACKGROUND: Most people with type 2 diabetes (T2D) have glycaemic levels outside of target. Insulin is effective in improving glycaemia and most people with T2D eventually need this. Despite this, transition to insulin therapy is often delayed in primary care. OBJECTIVE: To develop a model of care (Stepping Up) for insulin initiation in routine diabetes care in Australian general practice. To evaluate the model for feasibility of integration within routine general practice care. METHODS: Drawing on qualitative work and normalisation process theory, we developed a model of care that included clarification of roles, in-practice systems and simple clinical tools. The model was introduced in an educational and practice system change intervention for general practitioners (GPs) and practice nurses (PNs). Five practices (seven GPs and five PNs) and 18 patients formed the feasibility study. Evaluation at 3 and 12 months explored experiences of GPs, PNs and patients. RESULTS: Fourteen patients commenced insulin, with average HbA1c falling from 8.4% (68.3 mmol/mol) to 7.5% (58.5 mmol/mol) at 3 months. Qualitative evaluation highlighted how the model of care supported integration of the technical work of insulin initiation within ongoing generalist GP care. Ensuring peer support for patients and issues of clinical accountability and flexibility, managing time and resources were highlighted as important. CONCLUSIONS: The Stepping Up model allowed technical care to be embedded within generalist whole-person care, supported clinicians and practice system to overcome clinical inertia and supported patients to make the timely transition to insulin. Testing of the model's effectiveness is now underway.
BACKGROUND: Most people with type 2 diabetes (T2D) have glycaemic levels outside of target. Insulin is effective in improving glycaemia and most people with T2D eventually need this. Despite this, transition to insulin therapy is often delayed in primary care. OBJECTIVE: To develop a model of care (Stepping Up) for insulin initiation in routine diabetes care in Australian general practice. To evaluate the model for feasibility of integration within routine general practice care. METHODS: Drawing on qualitative work and normalisation process theory, we developed a model of care that included clarification of roles, in-practice systems and simple clinical tools. The model was introduced in an educational and practice system change intervention for general practitioners (GPs) and practice nurses (PNs). Five practices (seven GPs and five PNs) and 18 patients formed the feasibility study. Evaluation at 3 and 12 months explored experiences of GPs, PNs and patients. RESULTS: Fourteen patients commenced insulin, with average HbA1c falling from 8.4% (68.3 mmol/mol) to 7.5% (58.5 mmol/mol) at 3 months. Qualitative evaluation highlighted how the model of care supported integration of the technical work of insulin initiation within ongoing generalist GP care. Ensuring peer support for patients and issues of clinical accountability and flexibility, managing time and resources were highlighted as important. CONCLUSIONS: The Stepping Up model allowed technical care to be embedded within generalist whole-person care, supported clinicians and practice system to overcome clinical inertia and supported patients to make the timely transition to insulin. Testing of the model's effectiveness is now underway.
Authors: Irene D Blackberry; John S Furler; Louise E Ginnivan; Hanan Derraz; Alicia Jenkins; Neale Cohen; James D Best; Doris Young; Danny Liew; Glenn Ward; Jo-Anne Manski-Nankervis; David N O'Neal Journal: BMC Fam Pract Date: 2014-05-03 Impact factor: 2.497
Authors: Carl R May; Amanda Cummings; Melissa Girling; Mike Bracher; Frances S Mair; Christine M May; Elizabeth Murray; Michelle Myall; Tim Rapley; Tracy Finch Journal: Implement Sci Date: 2018-06-07 Impact factor: 7.327
Authors: John S Furler; Doris Young; James Best; Elizabeth Patterson; David O'Neal; Danny Liew; Jane Speight; Leonie Segal; Carl May; Jo-Anne Manski-Nankervis; Elizabeth Holmes-Truscott; Louise Ginnivan; Irene D Blackberry Journal: Implement Sci Date: 2014-02-14 Impact factor: 7.327