Regional Primary Care Team to Deliver Best-Practice Diabetes Care A needs-driven health workforce model reflecting a biopsychosocial construct of health

Abstract

OBJECTIVE - Best-practice diabetes care can reduce the burden of diabetes and associated health care costs. But this requires access to a multidisciplinary team with the right skill mix.We applied a needs-driven evidence-based healthworkforcemodel to describe the primary care team required to support best-practice diabetes care, paying particular attention to diverse clinic populations. RESEARCH DESIGN AND METHODSd Care protocols, by number nd duration of consultations, were derived for twenty distinct competencies based on clinical practice guidelines and structured input from a multidisciplinary clinical panel. This was combined with previously estimated population profile of persons across 26 patient attributes (i.e. type of diabetes complications and threats to self-care) to estimate clinician contact hours by competency required to deliver best-practice care in the study region. RESULTS - A primary care team of 22.1 full-time-equivalent (FTE) positions was needed to deliver best-practice primary care to a catchment of 1000 persons with diabetes with the attributes of the Australian population. Competencies requiring greatest contact time were psychosocial issues and dietary advice at 3.5 and 3.3 FTE respectively (1 FTE/;300 persons); home (district) nursing at 3.2 FTE; and diabetes education at 2.8 FTE. The annual cost of delivering care was estimated at just over 2000 Australian dollars (;2090 USD) (2012) per person with diabetes. CONCLUSIONS - A needs-driven approach to primary care service planning identified a wider range of competencies in the diabetes primary and community care team than typically described. Access to psychosocial competences as well as medical management is required if clinical targets are to be met especially in disadvantaged Groups. © 2013 by the American Diabetes Association.