Community Program Aims to Reduce Disparities in Diabetes Care

When patients who are socioeconomically deprived develop diabetes, the course of their illness is usually more complicated than that of patients who have better resources. Many of these patients have high levels of mental illness, multiple comorbidities, and unmet needs.

A clinical research team in the UK, concerned about disparities in care and poor outcomes in London's growing diabetes population, developed 3DFD (3 Dimensions of Care for Diabetes). They designed this program with 4 outcomes in mind:

• improved glycemic control
• reduced psychological distress
• improved care quality and patient-reported outcomes, and
• reduced health care costs.

The result is a program that helps patients with suboptimal glycemic control (HbA1c >9%) receive a full array of services that increase the likelihood of success. Its award winning structure could serve as a template for US communities with similar challenges.

3DFD integrates medical care, psychiatry, social work, and pharmaceutical care. Their small team includes a liaison psychiatrist who provides clinical leadership and psychiatric interventions, 2 part-time psychologists, and 2 social support workers.

The social work aspect is critical, as it is community-based and the community support workers work directly with diabetes teams. Patients also take an important lead in their care, leading team discussions and reporting outcomes.

These clinical researchers have conducted 3 pilot programs that have refined 3DFD's components and demonstrated effectiveness. Their model provides comprehensive care to at-risk patients, usually for 16 weeks.

The measurable end result has been significant improvements in glycemic control, psychological status and health service use.

They report some significant outcomes. Patients had 45% fewer emergency department visits, for example, and hospital admissions were reduced by more than 20%.

In a post-pilot survey, patients reported that they need high levels of care and reliable healthcare providers to become engaged.

This project is being evaluated for cost savings. Early analysis indicates they will save more than $50,000 annually, but the researchers believe the savings will grow and accumulate. The journal Practical Diabetes contains excellent coverage of this program in a recent issue. More information is also available on their web site.