PROJECT FUNDING: Service Delivery & Organisation (SDO) Programme (£298,471)
In the UK, community based intermediate care clinics for diabetes (ICCD) are an increasingly popular method of supporting primary care management of type 2 diabetes (T2DM). This approach has the potential to improve control of diabetes, enhance the patient experience, and reduce hospital outpatient attendance not only among patients referred to the ICCD service but also among other patients, as the practices gradually increase their expertise in managing diabetes. However to date there is little evidence of effectiveness or cost effectiveness of these services, and none has been evaluated in a randomised trial. The aims of this randomised controlled trial were to (i) compare clinical outcome in people with T2DM registered with practices that have access to an ICCD service with those that have access only to usual hospital care; (ii) assess the cost-effectiveness of the ICCD service intervention; and (ii) explore the views of users and other stakeholders. This trial also aimed to assess the effectiveness and cost-effectiveness of ICCD provision compare to usual hospital care for such patients.The trial demonstrates that providing practices with access to an ICCD service is associated with higher proportion of patients achieving recommended control of risk factors, although this difference just failed to reach statistical significance for the primary outcome of control of all three blood pressure, cholesterol and HbA1c. There was substantial variation in costs and clinical outcomes between the trial sites. Despite potential biases due to low recruitment and loss to follow up, we conclude that intermediate care clinics can make a contribution to improving target achievement in patients with diabetes. The qualitative interviews identified components of ICCD services that were important to patients and practitioners. These included close integration and communication with primary care, active involvement in identifying patients who could benefit from referral and an accessible location.Future ICCD services should be developed and monitored in collaboration with primary care, a process that will be facilitated by clinically led commissioning.