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A pilot study of an integrated mental health, social and medical model for diabetes care in an inner-city setting: Three Dimensions for Diabetes (3DFD).
Ismail, K; Stewart, K; Ridge, K; Britneff, E; Freudenthal, R; Stahl, D; McCrone, P; Gayle, C; Doherty, A M.
Affiliation
  • Ismail K; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
  • Stewart K; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
  • Ridge K; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
  • Britneff E; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
  • Freudenthal R; Diabetes Centre, King's College Hospital NHS Foundation Trust, London, UK.
  • Stahl D; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
  • McCrone P; Department of Psychological Medicine, Institute of Psychiatry, Psychology and Neurosciences, King's College London, London, UK.
  • Gayle C; Diabetes Centre, King's College Hospital NHS Foundation Trust, London, UK.
  • Doherty AM; Diabetes Centre, King's College Hospital NHS Foundation Trust, London, UK.
Diabet Med ; 37(10): 1658-1668, 2020 10.
Article in En | MEDLINE | ID: mdl-30706535
ABSTRACT

AIMS:

We examined the effectiveness of a service innovation, Three Dimensions for Diabetes (3DFD), that consisted of a referral to an integrated mental health, social care and diabetes treatment model, compared with usual care in improving biomedical and health economic outcomes.

METHODS:

Using a non-randomized control design, the 3DFD model was offered in two inner-city boroughs in London, UK, where diabetes health professionals could refer adult residents with diabetes, suboptimal glycaemic control [HbA1c ≥ 75 mmol/mol (≥ 9.0%)] and mental health and/or social problems. In the usual care group, there was no referral pathway and anonymized data on individuals with HbA1c ≥ 75 mmol/mol (≥ 9.0%) were collected from primary care records. Change in HbA1c from baseline to 12 months was the primary outcome, and change in healthcare costs and biomedical variables were secondary outcomes.

RESULTS:

3DFD participants had worse glycaemic control and higher healthcare costs than control participants at baseline. 3DFD participants had greater improvement in glycaemic control compared with control participants [-14 mmol/mol (-1.3%) vs. -6 mmol/mol (-0.6%) respectively, P < 0.001], adjusted for confounding. Total follow-up healthcare costs remained higher in the 3DFD group compared with the control group (mean difference £1715, 95% confidence intervals 591 to 2811), adjusted for confounding. The incremental cost-effectiveness ratio was £398 per mmol/mol unit decrease in HbA1c , indicating the 3DFD intervention was more effective and costed more than usual care.

CONCLUSIONS:

A biomedical, psychological and social criteria-based referral system for identifying and managing high-cost and high-risk individuals with poor glycaemic control can lead to improved health in all three dimensions.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Social Work / Delivery of Health Care / Diabetes Mellitus, Type 1 / Diabetes Mellitus, Type 2 / Mental Disorders / Mental Health Services Type of study: Clinical_trials / Diagnostic_studies / Prognostic_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: En Year: 2020 Type: Article

Full text: 1 Database: MEDLINE Main subject: Social Work / Delivery of Health Care / Diabetes Mellitus, Type 1 / Diabetes Mellitus, Type 2 / Mental Disorders / Mental Health Services Type of study: Clinical_trials / Diagnostic_studies / Prognostic_studies Limits: Adult / Aged / Female / Humans / Male / Middle aged Country/Region as subject: Europa Language: En Year: 2020 Type: Article