A pilot study of an integrated mental health, social and medical model for diabetes care in an inner-city setting: Three Dimensions for Diabetes (3DFD).
Autor: Ismail, K.; Stewart, K.; Ridge, K.; Britneff, E.; Freudenthal, R.; Stahl, D.; McCrone, P.; Gayle, C.; Doherty, A. M.
Publication year: 2020
Diabetic medicine : a journal of the British Diabetic Association
issn:1464-5491 0742-3071
doi: 10.1111/dme.13918
Abstract:
AIMS: We examined the effectiveness of a service innovation, Three Dimensions for Diabetes (3DFD), that consisted of a referral to an integrated mental health, social care and diabetes treatment model, compared with usual care in improving biomedical and health economic outcomes. METHODS: Using a non-randomized control design, the 3DFD model was offered in two inner-city boroughs in London, UK, where diabetes health professionals could refer adult residents with diabetes, suboptimal glycaemic control [HbA(1c) ≥ 75 mmol/mol (≥ 9.0%)] and mental health and/or social problems. In the usual care group, there was no referral pathway and anonymized data on individuals with HbA(1c) ≥ 75 mmol/mol (≥ 9.0%) were collected from primary care records. Change in HbA(1c) from baseline to 12 months was the primary outcome, and change in healthcare costs and biomedical variables were secondary outcomes. RESULTS: 3DFD participants had worse glycaemic control and higher healthcare costs than control participants at baseline. 3DFD participants had greater improvement in glycaemic control compared with control participants [-14 mmol/mol (-1.3%) vs. -6 mmol/mol (-0.6%) respectively, P < 0.001], adjusted for confounding. Total follow-up healthcare costs remained higher in the 3DFD group compared with the control group (mean difference £1715, 95% confidence intervals 591 to 2811), adjusted for confounding. The incremental cost-effectiveness ratio was £398 per mmol/mol unit decrease in HbA(1c) , indicating the 3DFD intervention was more effective and costed more than usual care. CONCLUSIONS: A biomedical, psychological and social criteria-based referral system for identifying and managing high-cost and high-risk individuals with poor glycaemic control can lead to improved health in all three dimensions. Language: eng Rights: © 2019 Diabetes UK. Pmid: 30706535 Tags: Humans; Aged; Female; Male; Adult; Middle Aged; Pilot Projects; Urban Population; Health Care Costs; London; Glycated Hemoglobin/metabolism; Delivery of Health Care/economics/*organization & administration; Diabetes Mellitus, Type 1/economics/metabolism/psychology/*therapy; Diabetes Mellitus, Type 2/economics/metabolism/psychology/*therapy; Health Services Administration; Health Services/economics; Mental Disorders/psychology/*therapy; Mental Health Services/economics/*organization & administration; Social Work/economics/*organization & administration Link: https://pubmed.ncbi.nlm.nih.gov/30706535/
