IDF2022-1042 Diabetes Specialist Intervention in General Practices in deprived and ethnically diverse areas

Background:
Diabetes, in all forms, imposes an unacceptably high human, social and economic cost on countries at all income levels and it is the fourth most common cause of death globally [1]. in Coventry, a medium-sized ethnically diverse UK city, low health literacy and language barriers hamper access to diabetes care for patients living in the deprived inner-city areas, leading to poorer self-management.
Aim:
To assess patients and healthcare professionals’ perspectives of a specialist-led Diabetes Risk-based Assessment Clinic (DIRAC) for people with diabetes at high risk of complications (PWDHRC) in deprived areas of Coventry.
Method:
A qualitative evaluation of a pilot trial (QUAN-ECLIPSE) of a specialist team intervention (DIRAC), was under-taken in seven GP practices. Data were collected by observations of weekly face-to-face or virtual patient consultations and monthly interventionists’ meetings; semi-structured interviews were carried out with PWDHRC, primary care clinicians, and interventionists, post-intervention. Thematic analyses of observations and interviews were undertaken.
Results:
An ever-changing patient pathway: The PWDHRC pathway is not smooth. However, for all participants, the intervention provided a structure for care and stability.
It’s all about that patient: PWDHRC experienced ‘a good deal’ with personalized care from the intervention. Cultural beliefs were addressed and PWDHRC felt empowered to self-manage. Learning from one another: All participants felt upskilled including PWDHRC, with clinicians acquiring knowledge on how
to manage PWDHRC locally. Interventionists felt they were making a difference to PWDHRC. Future innovative services: The technology utilized alongside
specialist clinical input during DIRAC enhanced diabetes management. However, challenges, such as cost and merging databases, require a whole systems approach for widespread implementation.
Conclusion:
The specialist-led DIRAC were appreciated by patients and primary care clinicians. The qualitative data support QUAN-ECLIPSE progressing to a full service evaluation.