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Over one-third of diabetes-related encounters with healthcare providers in Australia fail to meet clinical guidelines. Evidence is mounting that care provision within an integrated framework may facilitate greater adherence to clinical guidelines and improved outcomes for patients. The Diabetes Alliance Program was implemented across a large healthcare district to enhance diabetes care capacity at the primary care level through intensive case-conferencing involving the primary care team, patients and visiting specialist team, whole practice performance review and regular diabetes education for practitioners. Here, we provide an in-depth patient assessment of the case-conferencing process and impact on diabetes management. Two practices with high pre-intervention HbA1c monitoring and three practices with low HbA1c monitoring provided the sampling frame. Patients were selected according to their score on the Patient Activation MeasureTM to achieve maximum variation, with up to two patients with high scores and three with low scores, selected from each practice. Patients were sampled until data saturation was achieved and then subjected to thematic content analysis (n = 19). Patients mostly described the model of care as a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition). The program was also seen to be helpful in providing an opportunity to refocus when "life gets in the way". Other valued aspects of the program included the holistic approach to healthcare, reduced travel time, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Despite this, difficulties in coping with diabetes and adherence to treatment recommendations remained for a minority of patients. Integrating specialist teams within primary care has the ability to provide efficient healthcare delivery, better patient experience and health outcomes. Investment in such approaches will be critical to navigating healthcare provision in order to meet the demands of an ageing population.

Introduction: In Australia, over a third of encounters with health care providers for diabetic patients fail to provide clinical guideline appropriate care. The Diabetes Alliance, integrated care model implemented across a large healthcare district with a view to enhance diabetes care capacity at primary care through intensive case-conferencing with primary care team, patients and visiting specialist team; whole practice performance feedback, and; regular diabetes masterclasses. Here, we aimed to provide in-depth insight into the case-conferencing process and impact of the model of care for patients with diabetes. Methods: Patients from 5 practices (including 2 with high and 3 with low proportions of patients with a recent HbA1c) provided the sampling frame. Patients were selected according to Patient Activation Measure scores to achieve maximum variation with 1 or 2 patients with high scores and 2 or 3 patients with low scores were selected from each practice. Participants were sampled until saturation was achieved. Thematic content analysis was applied to the 19 interviews. Results: Patients largely found the model of care a positive experience, reporting a boost in confidence in diabetes self-management (particularly around nutrition), with the program providing an opportunity to refocus when “life gets in the way.” Other key aspects of the program that were viewed positively included the holistic approach to healthcare, reduced travel time and congestion, familiarity in environment and clinical care, top-down knowledge transfer as well as mutual learning by the patient and their primary care team. Patients however also described difficulties in coping with diabetes as a chronic illness and adherence to treatment recommendations. Conclusion: Providing timely integrated specialist care within the primary care setting is an efficient means of enhancing the engagement of diabetic patients with their diabetes care and therefore their outcomes. Disclosure D.O. Kuzulugil: None. M.L. Harris: None. J.E. Byles: None. M.E. Parsons: None. A.N. Philcox: None. S.H. Acharya: None.

The Hunter New England Local Health District (HNELHD) has 80,000 persons living with diabetes. Demand for public specialist care has been increasing annually resulting in long waiting times and inequity of access due to geographical location. A review of patients accessing publically funded tertiary diabetes care revealed that many patients could be managed by primary care clinicians, thus freeing tertiary services for complex patients. Primary care clinicians reported a lack of confidence providing best evidence care due to the rapid expansion in knowledge and therapeutics options for diabetes. The Diabetes Alliance was developed to overcome barriers to providing care in the general practices. This required partnerships between health organisations with different priorities, funding and reporting structures. The new model of care involves endocrinologists and diabetes educators working with general practitioners (GP) and practice nurses (PN) in the GP practice with the primary objectives of improving knowledge, confidence and skills. Practices are offered 2-3 days of case conferencing with 10 patients/day followed by brief visits at 6 and 12 months. The model incorporates data driven education and quality improvement support through partnership with the NPS MedicineWise MedicineInsight program. The target population are GP practices within HNELHD. The patient population is>18 years with Type 2 diabetes (T2DM), HbA1c >53 mmol/mol, not actively receiving diabetes care privately. Stakeholders include Hunter New England Local Health District, Hunter and Central Coast Primary health network, NPS MedicineWise, tertiary diabetes teams, primary care clinicians and patients. The pilot project commenced in 2015, but overwhelming primary and tertiary clinician support of the program has ensured policy changes required have been readily endorsed allowing the program to be scaled up efficiently and sustainably into an ongoing program. The program has broken down geographical, financial and traditional barriers between primary and tertiary care. By integrating and providing care in locations close to and trusted by the patient, the program has improved access to specialist care whilst simultaneously upskilling GPs to provide better care to all patients. The MedicineInsight reporting allow practices to identify, stratify and actively manage patients as well as providing a mechanism to monitor agreed quality improvement goals. Reporting also allows the Alliance partner administrators to allocate resources effectively. From May 2015 to June 2017, 830 patients have been seen in 50 GP practices. Did not attend rates is 3% compared to 22% in hospital based diabetes clinics. Preliminary data has demonstrated statistically significant improvement in HbA1c, weight, total cholesterol and systolic blood pressure. This integrated model of care can be applied to many chronic diseases. Although originally founded in metropolitan Newcastle it has since been rolled out to rural and remote practices including Aboriginal Medical Services. The Alliance has demonstrated the benefits of integrating care between primary and tertiary clinicians for patients with T2DM for both the individual patient and the health system as a whole. Through integration, the model has improved trust between clinicians and sharing of data has allowed improvement in identifying health needs across the district as well as providing a basis for local quality improvement in GP practices.

Evidence-based standardised diabetes care is difficult to achieve in the community due to resource limitations, and lack of equitable access to specialist care leads to poor clinical outcomes. This study reports a quality improvement program in diabetes health care across a large health district challenged with significant rural and remote geography and limited specialist workforce. An integrated diabetes care model was implemented, linking specialist teams with primary care teams through capacity enhancing case-conferencing in general practice supported by comprehensive performance feedback with regular educational sessions. Initially, 20 practices were recruited and 456 patients were seen over 14 months, with significant improvements in clinical parameters. To date 80 practices, 307 general practitioners, 100 practice nurses and 1400 patients have participated in the Diabetes Alliance program and the program envisages enrolling 40 new practices per year, with a view to engage all 314 practices in the health district over time. Diabetes care in general practice appears suboptimal with significant variation in process measures. An integrated care model where specialist teams are engaged collaboratively with primary care teams in providing education, capacity enhancing case-conferences and performance monitoring may achieve improved health outcomes for people with diabetes.