Collaborative diabetes virtual clinics – a service evaluation and clinical audit

Abstract

Abstract Background: Diabetes management in primary care is becoming increasingly complex. Integrated working between primary and specialist care teams is important in addressing this complexity. Diabetes virtual clinics (DVC) provide an opportunity for the diabetes specialist team to work collaboratively with the primary care team. Aim: To evaluate the impact of a DVC on the clinical management and care outcomes of patients in primary care settings. Methods: A prospective clinical audit of DVC patients was performed in seven general practices comparing data, at baseline and at 6 months. The audit measured changes in care provision and clinical performance. The primary audit standard was that 50% of cases with a baseline glycated haemoglobin (HbA1c) ≥58 mmol/mol (7.5%) would optimise HbA1c by a clinical significant reduction of 6 mmol/mol (0.4%). Results: The audit examined 113 cases that were exposed to the DVC. Data were available on 73 cases at 6 months. The main theme for case discussion was treatment modification and titration (48%, n = 54), followed by: managing co-morbidities (24%, n = 21) and psychosocial factors (14%, n = 12). Primary care was the most common pathway identified, 35% (n = 40) cases avoided being referred to specialist care and 21 (23%) cases were transferred from specialist to primary care. At 6 months, HbA1c reduced by 7 mmol/mol (0.46%) from 73 mmol/mol (8.79%) to 67 mmol/mol (8.32%), p = 0.001. The audit standards were exceeded with 85% of patients achieving an improvement in their glycaemic control and 57% having a reduction in the HbA1c of ≥6 mmol/mol (0.4%). Conclusions: The DVC resulted in a clinically and statistically significant improvement in HbA1c. It has also meant that more patients can be treated in primary care without the need for referral to specialists. The DVC could be an effective model for integrated working between primary and diabetes specialist services, providing an opportunity for shared learning.