English approaches to integrated diabetes care: The east Cambridgeshire and Fenland diabetes integrated care initiative: A multiple provider approach

Abstract

Integrated care has been proposed as a means to improve diabetes outcomes within the English National Health Service. The Diabetes Integrated Care Initiative (DICI) was delivered by a separate enhanced community diabetes service in Cambridgeshire, East England, increasing specialist support to primary care and patients. The DICI was evaluated using a mixed methods approach, including a before-after design, with controls from adjacent geographical areas and patients without diabetes. The clinical service was fully implemented, but vertical integration (e.g. integrated governance, information management, health-care professional education and management) did not occur. In spite of early promise, after 3 years, patient admission rates among intervention area patients with diabetes increased 7.4 (5.2-9.2)% and 45.5 (42.5-48.5)% greater than in control areas. There was no reduction in the rate of increase in diabetic foot, non-elective or other hospital admissions or improvement in metabolic outcomes. We conclude that positioning an intermediate/community service between primary and secondary care, was an ineffective approach to integration. It created a barrier, rather than a bridge, to better diabetes outcomes.