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Differential shared care for diabetes: does it provide the optimal partition between primary and specialist care?
Author(s) -
Overland J.,
Mira M.,
Yue D. K.
Publication year - 2001
Publication title -
diabetic medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.474
H-Index - 145
eISSN - 1464-5491
pISSN - 0742-3071
DOI - 10.1046/j.1464-5491.2001.00521.x
Subject(s) - medicine , referral , odds ratio , confidence interval , shared care , diabetes mellitus , family medicine , pediatrics , primary care , endocrinology
Aims To establish whether a system of differential shared care between general practitioners and specialists is compatible with patients receiving the level of care they require. Methods We sought to trace 200 shared care patients whose care had been kept at the general practitioner level after initial referral and compared them with a group of patients who had been re‐referred to the Royal Prince Alfred Hospital Diabetes Centre for specialist review. Results There were no significant differences in glycaemic, blood pressure and lipid levels of returned and non‐returned patients at initial assessment. However, non‐returned patients were less likely to have a history of macrovascular disease or risk factor (adjusted odds ratio (OR) 0.4; 95% confidence interval (CI) 0.2–0.6). Their referral letter was also more likely to emphasize their type and/or duration of diabetes (adjusted OR 4.6; 95% CI 2.5–8.4). Nearly half (47.1%) of the non‐returned group changed their doctor in the years following their initial specialist review, increasing their likelihood of not being re‐referred five‐fold (adjusted OR 5.0; 95% CI 2.9–8.8). At initial assessment, non‐returned patients were given less treatment recommendations (adjusted OR 0.5; 95% CI 0.3–0.7). Doctors registered with the Diabetes Shared Care Programme referred more patients than their non‐shared care counterparts. However, a higher proportion of these doctors (52.5% vs. 21.3%; χ 2 = 16.5, 1 d.f., P = 0.00005) were selective in whom they re‐referred. Conclusion Differential shared care encourages appropriate referral to specialist services, without compromise to standards of care. Diabet. Med. 18, 554–557 (2001)