Improving the structure of diabetes care in primary care: A pilot study.

Abstract

The aim of this pilot study was to determine whether glycemic control can be improved in patients with type 2 diabetes by implementing a workshop model to improve the structure of diabetes care at primary health care centers (PHCCs). The intervention consisted of 4 workshops at 12 PHCCs with HbA1c >70 mmol/mol (high HbA1c). Each PHCC could choose how many workshops they wished to attend and was to be represented by the manager, a diabetes nurse, and a GP. Participants analyzed the structure of diabetes care at their PHCC and developed an action plan to improve it. The percentage of patients with high HbA1c at baseline, 12, and 24 months was collected. Qualitative content analysis was also conducted. All PHCCs reduced the percentage of patients with high HbA1c 12 months after the intervention, but not all maintained the reduction at 24 months. Participants experienced structuring diabetes care as central to reducing the percentage of patients with high HbA1c. Pillars of structured diabetes care included establishing routines, working in teams, and having and implementing an action plan. Working with the structure of diabetes care improved care structure and had a positive impact on HbA1c. To sustain the positive impact, PHCCs had to set long-term goals and regularly evaluate performance.