With nearly two million Canadians living with diabetes today, and type 2 diabetes becoming one of the fastest-growing diseases in the country, treatment and education are pressing issues for public health policy-makers. The realities of managing the lifelong disease, however, are complex, and often involve time-intensive services that many general health-care practitioners, already overburdened, don’t have time to provide. Enza Gucciardi, a professor in the School of Nutrition, has been pilot testing new models of care that can benefit both patients and doctors.
“The way we deliver health services is fragmented in Ontario,” says Gucciardi, who has been evaluating the effectiveness of integrated diabetes education and treatment teams in 11 locations across Ontario. Connected to larger hospitals, such as Trillium Health Centre or St. Michael’s Hospital, these teams of mobile nurses and dietitian educators deliver specialized diabetes care services, such as diet consultation and insulin therapy initiation, directly to local neighbourhood practices a few times a month. Learning how to take and adjust insulin levels, for example, can be a weeks-long process with plenty of follow-up, and is often an intimidating and involved process for first-time patients. Diabetes educators have the expertise and time to follow through with this initiation.
“Primary practitioners are generalists,” says Gucciardi, “and it’s challenging to know everything regarding diabetes management. A lot of patient cases are complicated. Having specialists on-site is helpful for them, and it increases quality of care.”
These mobile teams offer multiple advantages. They give general practitioners additional specialized care when needed, and help patients overcome access issues, such as limited time availability and transportation costs—setting up appointments at larger urban hospitals is often a barrier, Gucciardi’s research has found.
Perhaps most important, they increase both the patient and physician’s awareness of these specialized services in the first place. It has been reported that only 25 to 30 per cent of patients eligible for specialized diabetes care actually use these services. “Patients need to be aware these programs exist, and referral is a major issue. It’s still a recurring problem, even for these mobile teams on-site,” Gucciardi says. BY CHANTAL BRAGANZA