PMID- 10414931
OWN - NLM
STAT- MEDLINE
DCOM- 19990908
LR  - 20221207
IS  - 0168-8227 (Print)
IS  - 0168-8227 (Linking)
VI  - 44
IP  - 2
DP  - 1999 May
TI  - Diabetes management: shared care or shared neglect.
PG  - 123-8
AB  - Shared care is increasingly being advocated as a way of managing patients with 
      diabetes. While this approach has been supported by clinical trials, the success 
      of shared care in 'real life' is not well established. If health care 
      professionals leave undone what they think is done by others, shared care can 
      become neglected care. Follow up of 200 'shared care' patients who had been 
      referred to the Royal Prince Alfred Diabetes Centre, Sydney, Australia on two or 
      more occasions between October 1995 and September 1998 showed that the majority 
      of specialist recommendations regarding metabolic control (76%), referral to an 
      ophthalmologist (73%) and blood pressure treatment (76%) had been implemented by 
      the primary care physician; however, they were less likely to implement 
      recommendations regarding lipid treatment (55%). The median HbA1c (7.6% vs. 8.4%; 
      P = 0.04), cholesterol (5.6 vs. 6.8 mmol/l; P = 0.0005) and triglyceride (2.0 vs. 
      2.8 mmol/l; P = 0.05) levels for patients in whom recommendations had been 
      implemented were significantly lower at the time of second referral. Doctors 
      registered with the Diabetes Shared Care Programme and those who wrote longer 
      letters were more likely to implement recommendations than their counterparts 
      (87.2%, versus 70.9%; chi2 = 4.12, 1 df; P = 0.04 and 56 words (inter-quartile 
      range (IQR): 36-71) versus 45 words (IQR: 23-59); P = 0.02, respectively). It 
      therefore appears that diabetes care can be well provided by a shared care 
      approach. However, further monitoring of different shared care models is 
      warranted.
FAU - Overland, J
AU  - Overland J
AD  - Diabetes Centre of Royal Prince Alfred Hospital, The Department of Medicine, The 
      University of Sydney, Camperdown, NSW, Australia. jane@diab.rpa.cs.nsw.gov.au
FAU - Mira, M
AU  - Mira M
FAU - Yue, D K
AU  - Yue DK
LA  - eng
PT  - Journal Article
PL  - Ireland
TA  - Diabetes Res Clin Pract
JT  - Diabetes research and clinical practice
JID - 8508335
RN  - 0 (Cholesterol, HDL)
RN  - 0 (Glycated Hemoglobin A)
RN  - 0 (Triglycerides)
RN  - 97C5T2UQ7J (Cholesterol)
SB  - IM
MH  - Australia
MH  - Blood Pressure
MH  - Cholesterol/blood
MH  - Cholesterol, HDL/blood
MH  - Diabetes Mellitus/blood/physiopathology/*therapy
MH  - Family Practice
MH  - Female
MH  - Glycated Hemoglobin/analysis
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Outpatient Clinics, Hospital/organization & administration
MH  - *Patient Care Team
MH  - Referral and Consultation
MH  - Triglycerides/blood
EDAT- 1999/07/22 00:00
MHDA- 1999/07/22 00:01
CRDT- 1999/07/22 00:00
PHST- 1999/07/22 00:00 [pubmed]
PHST- 1999/07/22 00:01 [medline]
PHST- 1999/07/22 00:00 [entrez]
AID - S0168-8227(99)00016-9 [pii]
AID - 10.1016/s0168-8227(99)00016-9 [doi]
PST - ppublish
SO  - Diabetes Res Clin Pract. 1999 May;44(2):123-8. doi: 
      10.1016/s0168-8227(99)00016-9.