PROMPTING THE CLINICAL CARE OF NON-INSULIN-DEPENDENT (TYPE-II) DIABETIC-PATIENTS IN AN INNER-CITY AREA - ONE MODEL OF COMMUNITY CARE

Objective-To evaluate the effectiveness and acceptability of centrally organised prompting for coordinating community care of non-insulin dependent diabetic patients. Design-Randomised single centre trial. Patients allocated to prompted care in the community or to, continued attendance at hospital diabetic clinic (controls). Median follow up two years. Setting-Two hospital outpatient clinics, 38 general practices, and 11 optometrists in the catchment area of a district general hospital in Islington. Patients-181 patients attending hospital outpatient clinics. Null hypothesis-There is no difference in process of medical care measures and medical outcome between prompted community care and hospital clinic care. Results-14 hospital patients failed to receive a single review in the clinic as compared with three patients in the prompted group (chi2=6.1, df=1; p=0.013). Follow up for retinal screening was better in prompted patients than in controls; two prompted patients defaulted as against 12 controls (chi2=6.9, df=1; p=0.008). Three measures per patient yearly were more frequent in prompted patients: tests for albuminuria (median 3.0 v 2.3; p=0.03), plasma glucose estimations (3.1 v 2.5; p=0.003), and glycated haemoglobin estimations (2-4 v 0-9; p<0.001). Continuity of care was better in the prompted group (3.2 v 2.2 reviews by each doctor seen; p<0.001). The study ended with no significant differences between the groups in last recorded random plasma glucose concentration, glycated haemoglobin value, numbers admitted to hospital for a diabetes related reason, and number of deaths. Questionnaires revealed a high level of patient, general practitioner, and optometrist satisfaction. Conclusions-Six monthly prompting of non-insulin treated diabetic patients for care by inner city general practitioners and by optometrists is effective and acceptable.