PMCCPMCCPMCC

Search tips
Search criteria 

Advanced

 
Logo of bmjThe BMJ
 
BMJ. 1994 May 7; 308(6938): 1208–1212.
PMCID: PMC2540045

Integrated care for diabetes: clinical, psychosocial, and economic evaluation. Diabetes Integrated Care Evaluation Team.

Abstract

OBJECTIVES--To evaluate integrated care for diabetes in clinical, psychosocial, and economic terms. DESIGN--Pragmatic randomised trial. SETTING--Hospital diabetic clinic and three general practice groups in Grampian. PATIENTS--274 adult diabetic patients attending a hospital clinic and registered with one of three general practices. INTERVENTION--Random allocation to conventional hospital clinic care or integrated care. Integrated care patients seen in general practice every three or four months and in the hospital clinic annually. General practitioners were given written guidelines for integrated care. MAIN OUTCOME MEASURES--Metabolic control, psychosocial status, knowledge of diabetes, beliefs about control of diabetes, satisfaction with treatment, disruption of normal activities, numbers of consultations and admissions, frequency of metabolic monitoring, costs to patients and NHS. RESULTS--A higher proportion of patients defaulted from conventional care (14 (10%)) than from integrated care (4 (3%), 95% confidence interval of difference 2% to 13%). After two years no significant differences were found between the groups in metabolic control, psychosocial status, knowledge, beliefs about control, satisfaction with treatment, unscheduled admissions, or disruption of normal activities. Integrated care was as effective for insulin dependent as non-insulin dependent patients. Patients in integrated care had more visits and higher frequencies of examination. Costs to patients were lower in integrated care (mean 1.70 pounds) than in conventional care (8 pounds). 88% of patients who experienced integrated care wished to continue with it. CONCLUSIONS--This model of integrated care for diabetes was at least as effective as conventional hospital clinic care.

Full text

Full text is available as a scanned copy of the original print version. Get a printable copy (PDF file) of the complete article (1.0M), or click on a page image below to browse page by page. Links to PubMed are also available for Selected References.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.
  • Thorn PA, Russell RG. Diabetic clinics today and tomorrow: mini-clinics in general practice. Br Med J. 1973 Jun 2;2(5865):534–536. [PMC free article] [PubMed]
  • Singh BM, Holland MR, Thorn PA. Metabolic control of diabetes in general practice clinics: comparison with a hospital clinic. Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):726–728. [PMC free article] [PubMed]
  • Wilkes E, Lawton EE. The diabetic, the hospital and primary care. J R Coll Gen Pract. 1980 Apr;30(213):199–206. [PMC free article] [PubMed]
  • Hayes TM, Harries J. Randomised controlled trial of routine hospital clinic care versus routine general practice care for type II diabetics. Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):728–730. [PMC free article] [PubMed]
  • Day JL, Humphreys H, Alban-Davies H. Problems of comprehensive shared diabetes care. Br Med J (Clin Res Ed) 1987 Jun 20;294(6587):1590–1592. [PMC free article] [PubMed]
  • Hurwitz B, Goodman C, Yudkin J. Prompting the clinical care of non-insulin dependent (type II) diabetic patients in an inner city area: one model of community care. BMJ. 1993 Mar 6;306(6878):624–630. [PMC free article] [PubMed]
  • Reith SB. Caring for diabetics in central Scotland. Diabet Med. 1985 Sep;2(5):417–419. [PubMed]
  • Kopelman P, Keable-Elliott D. An inner city district diabetic care scheme. Diabet Med. 1990 Jul;7(6):558–560. [PubMed]
  • Petrie JC, Robb OJ, Webster J, Scott AK, Jeffers TA, Park MD. Computer assisted shared care in hypertension. Br Med J (Clin Res Ed) 1985 Jun 29;290(6486):1960–1962. [PMC free article] [PubMed]
  • Husdan H, Rapoport A. Estimation of creatinine by the Jaffe reaction. A comparison of three methods. Clin Chem. 1968 Mar;14(3):222–238. [PubMed]
  • Meadows KA, Fromson B, Gillespie C, Brewer A, Carter C, Lockington T, Clark G, Wise PH. Development, validation and application of computer-linked knowledge questionnaires in diabetes education. Diabet Med. 1988 Jan;5(1):61–67. [PubMed]
  • Bradley C, Lewis KS. Measures of psychological well-being and treatment satisfaction developed from the responses of people with tablet-treated diabetes. Diabet Med. 1990 Jun;7(5):445–451. [PubMed]
  • Bradley C, Brewin CR, Gamsu DS, Moses JL. Development of scales to measure perceived control of diabetes mellitus and diabetes-related health beliefs. Diabet Med. 1984 Sep;1(3):213–218. [PubMed]
  • Hoskins PL, Fowler PM, Constantino M, Forrest J, Yue DK, Turtle JR. Sharing the care of diabetic patients between hospital and general practitioners: does it work? Diabet Med. 1993 Jan-Feb;10(1):81–86. [PubMed]
  • Parnell SJ, Zalin AM, Clarke CW. Care of diabetic patients in hospital clinics and general practice clinics: a study in Dudley. Br J Gen Pract. 1993 Feb;43(367):65–69. [PMC free article] [PubMed]
  • Pringle M, Stewart-Evans C, Coupland C, Williams I, Allison S, Sterland J. Influences on control in diabetes mellitus: patient, doctor, practice, or delivery of care? BMJ. 1993 Mar 6;306(6878):630–634. [PMC free article] [PubMed]
  • Hammersley MS, Holland MR, Walford S, Thorn PA. What happens to defaulters from a diabetic clinic? Br Med J (Clin Res Ed) 1985 Nov 9;291(6505):1330–1332. [PMC free article] [PubMed]
  • Croxson SC, Burden AC, Bodington M, Botha JL. The prevalence of diabetes in elderly people. Diabet Med. 1991 Jan;8(1):28–31. [PubMed]
  • Home P, Walford S. Diabetes care: whose responsibility? Br Med J (Clin Res Ed) 1984 Sep 22;289(6447):713–714. [PMC free article] [PubMed]

Articles from The BMJ are provided here courtesy of BMJ Publishing Group