INTEGRATED CARE FOR DIABETES - CLINICAL, PSYCHOSOCIAL, AND ECONOMIC-EVALUATION

Objectives-To evaluate integrated care for diabetes in clinical, psych osocial, and economic terms. Design-Pragmatic randomised trial. Settin g-Hospital diabetic clinic and three general practice groups in Grampi an. Patients-274 adult diabetic patients attending a hospital clinic a nd registered with one of three general practices. Intervention-Random allocation to conventional hospital clinic care or integrated care. I ntegrated care patients seen in general practice every three or four m onths and in the hospital clinic annually. General practitioners were given written guidelines for integrated care. Main outcome measures-Me tabolic control, psychosocial status, knowledge of diabetes, beliefs a bout control of diabetes, satisfaction with treatment, disruption of n ormal activities, numbers of consultations and admissions, frequency o f metabolic monitoring, costs to patients and NHS. Results-A higher pr oportion of patients defaulted from conventional care (14 (10%)) than from integrated care (4 (3%), 95% confidence interval of difference 2% to 13%). After two years no significant differences were found betwee n the groups in metabolic control, psychosocial status, knowledge, bel iefs about control, satisfaction with treatment, unscheduled admission s, or disruption of normal activities. Integrated care was as effectiv e for insulin dependent as non-insulin dependent patients. Patients in integrated care had more visits and higher frequencies of examination . Costs to patients were lower in integrated care (mean pound 1.70) th an in conventional care (pound 8). 88% of patients who experienced int egrated care wished to continue with it. Conclusions-This model integr ated care for diabetes was at least as effective as conventional hospi tal clinic care.