Overcoming disparities in diabetes care: eight years' experience changing the diabetes care system in Changhua, Taiwan

Abstract

Aims: To enhance the universal coverage of quality diabetes care and overcome disparities in care among different care-provider levels by changing the diabetes care system in Changhua, Taiwan.

Methods: The Changhua Diabetes Shared Care program's second stage commenced in 2004. Two levels of diabetes care were proposed to facilitate physician participation via advocating the more attainable goals of diabetes care. The empowerment processes were differentiated into hospital-level and primary-care-clinic-level. The community multidisciplinary care teams took the scale of the practices into consideration, and several measures were applied to ameliorate the shared care network. The implementation support team from the health authority initiated in-person, one-on-one contacts with physicians to tailor collaboration activities to the individual primary care settings. The program's performance (2004-2012) was evaluated according to the RE-AIM model's five dimensions.

Results: There was substantial improvement in diabetes care quality across all dimensions and the proportion of attaining all goals significantly grew.

Conclusions: The program achieved its primary goal of enhancing the universal coverage of quality diabetes care and overcoming disparities among different levels of care providers.

Keywords: Chronic care model; Chronic disease management; Diabetes shared care; Disparity; Primary care.