The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Edward Zimbudzi; Clement Lo; Tracy Robinson; Sanjeeva Ranasinha; Helena J Teede; Tim Usherwood; Kevan R Polkinghorne; Peter G Kerr; Gregory Fulcher; Martin Gallagher; Stephen Jan; Alan Cass; Rowan Walker; Grant Russell; Greg Johnson; Sophia Zoungas

doi:10.1371/journal.pone.0219685

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

PLoS One. 2019 Jul 15;14(7):e0219685. doi: 10.1371/journal.pone.0219685. eCollection 2019.

Authors

Edward Zimbudzi^{1

2}, Clement Lo^{1

3}, Tracy Robinson¹, Sanjeeva Ranasinha¹, Helena J Teede^{1

3}, Tim Usherwood^{4

5}, Kevan R Polkinghorne^{2

6}, Peter G Kerr^{2

6}, Gregory Fulcher^{7

8}, Martin Gallagher^{4

9}, Stephen Jan^{4

10}, Alan Cass^{4

11}, Rowan Walker¹², Grant Russell¹³, Greg Johnson¹⁴, Sophia Zoungas^{1

3

4}

Affiliations

¹ School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia.
² Department of Nephrology, Monash Health, Melbourne, Australia.
³ Diabetes and Vascular Medicine Unit, Monash Health, Melbourne, Australia.
⁴ The George Institute for Global Health, University of New South Wales, Sydney, Australia.
⁵ Department of General Practice, Sydney Medical School, University of Sydney, Sydney, Australia.
⁶ School of Clinical Sciences, Monash University, Melbourne, Australia.
⁷ Department of Diabetes, Endocrinology & Metabolism, Royal North Shore Hospital, University of Sydney, Sydney, Australia.
⁸ Northern Clinical School, University of Sydney, Sydney, Australia.
⁹ Concord Clinical School, University of Sydney, Sydney, Australia.
¹⁰ Sydney Medical School, University of Sydney, Sydney, Australia.
¹¹ Menzies School of Health Research, Darwin, Australia.
¹² Department of Renal Medicine, Alfred Health, Melbourne, Australia.
¹³ School of Primary Health Care, Monash University, Melbourne, Australia.
¹⁴ Diabetes Australia, Canberra, Australia.

Abstract

Background: To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service.

Objective: In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service.

Methods: 5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers.

Results: The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients.

Conclusions: Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Aged
Attitude of Health Personnel
Australia / epidemiology
Diabetes Complications / therapy*
Diabetes Mellitus / therapy*
Female
Focus Groups
Health Services Accessibility
Humans
Kidney
Male
Middle Aged
Models, Organizational
Nephrology / organization & administration
Practice Guidelines as Topic
Primary Health Care / organization & administration
Qualitative Research*
Referral and Consultation
Renal Insufficiency, Chronic / complications
Renal Insufficiency, Chronic / therapy*
Self Care
Specialization

Grants and funding

This study was supported by a National Health and Medical Research Council, Australia Partnership Grant (ID 1055175)-(URL https://www.nhmrc.gov.au/) between the following health services, research institutes and national consumer stakeholder groups – Alfred Health; Concord Hospital; Royal North Shore Hospital; Monash Health; Monash Centre for Health Research and Implementation, Monash University; The George Institute for Global Health, University of Sydney; Diabetes Australia; and Kidney Health Australia. CL was supported by an Australian Postgraduate Award Scholarship. HT was supported by a NHMRC, Australia Fellowship. SZ was supported by a National Heart Foundation of Australia Fellowship. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.