Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

Chrysanthi Papoutsi; Dougal Hargreaves; Ann Hagell; Natalia Hounsome; Helen Skirrow; Koteshwara Muralidhara; Grainne Colligan; Anne Ferrey; Shanti Vijayaraghavan; Trish Greenhalgh; Sarah Finer

doi:10.1186/s12916-022-02654-0

Implementation and delivery of group consultations for young people with diabetes in socioeconomically deprived, ethnically diverse settings

BMC Med. 2022 Nov 25;20(1):459. doi: 10.1186/s12916-022-02654-0.

Authors

Affiliations

¹ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK. chrysanthi.papoutsi@phc.ox.ac.uk.
² School of Public Health, Imperial College London, London, UK.
³ Association for Young People's Health, London, UK.
⁴ Brighton and Sussex Medical School, Brighton, UK.
⁵ London Northwest University Healthcare NHS Trust, London, UK.
⁶ Centre for Primary Care and Public Health, Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
⁷ Nuffield Department of Primary Care Health Sciences, University of Oxford, Radcliffe Observatory Quarter, Woodstock Road, Oxford, OX2 6GG, UK.
⁸ Barts Health NHS Trust, London, UK.

Abstract

Background: Young people with diabetes experience poor clinical and psychosocial outcomes, and consider the health service ill-equipped in meeting their needs. Improvements, including alternative consulting approaches, are required to improve care quality and patient engagement. We examined how group-based, outpatient diabetes consultations might be delivered to support young people (16-25 years old) in socio-economically deprived, ethnically diverse settings.

Methods: This multi-method, comparative study recruited a total of 135 young people with diabetes across two implementation and two comparison sites (2017-2019). Informed by a 'researcher-in-residence' approach and complexity theory, we used a combination of methods: (a) 31 qualitative interviews with young people and staff and ethnographic observation in group and individual clinics, (b) quantitative analysis of sociodemographic, clinical, service use, and patient enablement data, and (c) micro-costing analysis.

Results: Implementation sites delivered 29 group consultations in total. Overall mean attendance per session was low, but a core group of young people attended repeatedly. They reported feeling better understood and supported, gaining new learning from peers and clinicians, and being better prepared to normalise diabetes self-care. Yet, there were also instances where peer comparison proved difficult to manage. Group consultations challenged deeply embedded ways of thinking about care provision and required staff to work flexibly to achieve local tailoring, sustain continuity, and safely manage complex interdependencies with other care processes. Set-up and delivery were time-consuming and required in-depth clinical and relational knowledge of patients. Facilitation by an experienced youth worker was instrumental. There was indication that economic value could derive from preventing at least one unscheduled consultation annually.

Conclusions: Group consulting can provide added value when tailored to meet local needs rather than following standardised approaches. This study illustrates the importance of adaptive capability and self-organisation when integrating new models of care, with young people as active partners in shaping service provision.

Trial registration: ISRCTN reference 27989430.

Keywords: Complexity; Diabetes; Group consultations; Shared medical appointments; Young people.

Publication types

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

MeSH terms

Adolescent
Adult
Diabetes Mellitus*
Humans
Patient Participation
Referral and Consultation
Research Design
Self Care
Young Adult

Grants and funding

15/25/20/Health Services and Delivery Research Programme