The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Edward Zimbudzi; Clement Lo; Tracy Robinson; Sanjeeva  Ranasinha; Helena J. Teede; Tim  Usherwood; Kevan R.  Polkinghorne; Peter G. Kerr; Gregory  Fulcher; Martin  Gallagher; Stephen  Jan; Alan  Cass; Rowan  Walker; Grant Russell; Greg  Johnson; Sophia  Zoungas

doi:10.1371/journal.pone.0219685

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Edward Zimbudzi, Clement Lo, Tracy Robinson, Sanjeeva Ranasinha, Helena J. Teede, Tim Usherwood, Kevan R. Polkinghorne, Peter G. Kerr, Gregory Fulcher, Martin Gallagher, Stephen Jan, Alan Cass, Rowan Walker , Grant Russell, Greg Johnson, Sophia Zoungas

Nursing, Paramedicine and Healthcare Sciences

Research output: Contribution to journal › Article › peer-review

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Abstract

Background

To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service.

Objective

In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service.

Methods

5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers.

Results

The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients.

Conclusions

Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.

Original language	English
Article number	e0219685
Number of pages	13
Journal	PLoS One
Volume	14
Issue number	7
DOIs	https://doi.org/10.1371/journal.pone.0219685
Publication status	Published - 15 Jul 2019

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Zimbudzi, E., Lo, C., Robinson, T., Ranasinha, S., Teede, H. J., Usherwood, T., Polkinghorne, K. R., Kerr, P. G., Fulcher, G., Gallagher, M., Jan, S., Cass, A., Walker , R., Russell, G., Johnson, G., & Zoungas, S. (2019). The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study. PLoS One, 14(7), Article e0219685. https://doi.org/10.1371/journal.pone.0219685

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title = "The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study",

abstract = "Background To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service. Objective In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service. Methods 5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers. Results The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients. Conclusions Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging. ",

author = "Edward Zimbudzi and Clement Lo and Tracy Robinson and Sanjeeva Ranasinha and Teede, {Helena J.} and Tim Usherwood and Polkinghorne, {Kevan R.} and Kerr, {Peter G.} and Gregory Fulcher and Martin Gallagher and Stephen Jan and Alan Cass and Rowan Walker and Grant Russell and Greg Johnson and Sophia Zoungas",

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doi = "10.1371/journal.pone.0219685",

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Zimbudzi, E, Lo, C, Robinson, T, Ranasinha, S, Teede, HJ, Usherwood, T, Polkinghorne, KR, Kerr, PG, Fulcher, G, Gallagher, M, Jan, S, Cass, A, Walker , R, Russell, G, Johnson, G & Zoungas, S 2019, 'The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study', PLoS One, vol. 14, no. 7, e0219685. https://doi.org/10.1371/journal.pone.0219685

TY - JOUR

T1 - The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia

T2 - A qualitative study

AU - Zimbudzi, Edward

AU - Lo, Clement

AU - Robinson, Tracy

AU - Ranasinha, Sanjeeva

AU - Teede, Helena J.

AU - Usherwood, Tim

AU - Polkinghorne, Kevan R.

AU - Kerr, Peter G.

AU - Fulcher, Gregory

AU - Gallagher, Martin

AU - Jan, Stephen

AU - Cass, Alan

AU - Walker , Rowan

AU - Russell, Grant

AU - Johnson, Greg

AU - Zoungas, Sophia

PY - 2019/7/15

Y1 - 2019/7/15

N2 - Background To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service. Objective In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service. Methods 5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers. Results The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients. Conclusions Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.

AB - Background To address guideline-practice gaps and improve management of patients with both diabetes and chronic kidney disease (CKD), we involved patients, health professionals and patient advocacy groups in the co-design and implementation of an integrated diabetes-kidney service. Objective In this study, we explored the experiences of patients and health-care providers, within this integrated diabetes and kidney service. Methods 5 focus groups and 2 semi-structured interviews were conducted amongst attending patients, referring primary health professionals, and attending specialist health professionals. Maximal variation sampling was used for both patients and referring primary health professionals to ensure an equal representation of males and females, and patients of different CKD stages. All discussions were audiotaped and transcribed verbatim, before being thematically analysed independently by 2 researchers. Results The mean age (SD) for specialist health professionals, primary care professionals and patients who participated was 45 (11), 44 (15) and 68 (5) years with men being 50%, 80% and 76% of the participants respectively. Key strengths of the diabetes and kidney service were noted to be better integration of care and a perception of improved health and management of health. Whilst some aspects of access such as time between referral and initial appointment and having fewer appointments improved, other aspects such as in-clinic waiting times and parking remained problematic. Specialist health professionals noted that health professional education could be improved. Patient self-management was also noted by to be an issue with some patients requesting more information and some health professionals expressing difficulty in empowering some patients. Conclusions Health professionals and patients reported that a co-designed integrated diabetes kidney service improved integration of care and improved health and management of health. However, some aspects of the process of care, health professional education and patient self-management remained challenging.

U2 - 10.1371/journal.pone.0219685

DO - 10.1371/journal.pone.0219685

M3 - Article

C2 - 31306453

SN - 1932-6203

VL - 14

JO - PLoS One

JF - PLoS One

IS - 7

M1 - e0219685

ER -

The impact of an integrated diabetes and kidney service on patients, primary and specialist health professionals in Australia: A qualitative study

Abstract

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