Diabetes specialist intervention in general practices in areas of deprivation and ethnic diversity: A qualitative evaluation (QUAL-ECLIPSE)

• Published in: Primary care diabetes 2024-02, Vol.18 (1), p.37-43
• Main Authors: Zeh, Peter, Young, Annie, Gholap, Nitin, Randeva, Harpal, Robbins, Timothy, Johal, Kam, Patel, Shweta, O’Hare, J. Paul
• Format: Article
• Language: English
• Subjects: Attitude of Health Personnel; Cultural appropriateness; Diabetes; Diabetes Mellitus - diagnosis; Diabetes Mellitus - therapy; Ethnic diversity; General Practice; GP practice-based service; Health Personnel; Humans; Primary care clinicians; Risk Assessment; Specialist-led; Virtual clinics
• ISSN: 1751-9918; 1878-0210
• DOI: 10.1016/j.pcd.2023.10.012

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 areas of deprivation in Coventry, UK. A qualitative evaluation of a pilot trial, comprising a specialist team intervention (DIRAC), was undertaken in seven GP practices through observations of weekly virtual or occasional face-to-face patient consultations and monthly interventionists’ meetings. Semi-structured interviews were carried out post-intervention, with PWDHRC, primary care clinicians and diabetes specialists (interventionists). Thematic analyses of observations and interviews were undertaken. Over 12 months, 28 DIRAC clinics comprising 154 patient consultations and five interventionists’ meetings, were observed. 19 interviews were undertaken, PWDHRC experienced ‘culturally-sensitive care from a specialist-led clinic intervention encompassing integrated care. This model of care was recommended at GP practice level, all participants (PWDHRC, primary care clinicians and diabetes specialist interventionists) felt upskilled to deal with complex diabetes care. The EMIS and ECLIPSE technologies utilised during the intervention were perceived to positively contribute to diabetes management of PWDHRC despite reservations around cost and database. The specialist-led DIRACs were largely appreciated by study participants. These qualitative data support the trial progressing to a full-service evaluation. •Primary care virtual consultations using technologies have potency in DM care management.•PWDHRCs experienced ‘a good deal' with culturally-sensitive integrated diabetes care.•All participants felt empowered to manage complex diabetes care post-intervention.•The DIRAC intervention provided a care structure and stability for participants involved.•The DIRAC intervention model of care at GP practice level is highly recommended.