Dr Ole Schmiedel1, Ms Leaisa Bartley2, Dr Sasini Wijayaratna3
1Auckland District Health Board, Auckland, New Zealand, 2Auckland District Health Board, Auckland, New Zealand, 3Auckland District Health Board, Auckland, New Zealand
Objectives: To investigate the impact of a clinical care coordinator on service delivery and equity outcomes at a tertiary Diabetes Centre.
Methods: The care coordinator receives referrals for high-risk type 1 and type 2 diabetes patients based on glycaemic control, recurrent hospital admissions, diabetes complications, and clinic non-attendance (did not arrive (DNA)). The care coordinator provides self-management support, bridges language, cultural and knowledge gaps, and helps patients & whānau navigate the healthcare system, ensuring well-coordinated care. All referrals were prospectively entered into a database; data collection was completed in October 2020. Clinic attendance, hospital admissions, and HbA1C data were collected six months before and after commencing care-coordinator involvement.
Results: Results from 181 referrals were included in the analysis; 54 referrals where patients were unable to be reached were excluded, and 88% (159/181) were Māori or Pacifika. The number of DNAs was reduced by 71% (374 in 181 patients pre-referral vs 108 post-referral). There were 49 hospital admissions in the six months pre-referral; this decreased by 57% to 21 admissions. 36 (20%) patients had at least one admission pre-referral, and only 15 (8%) had an admission during follow-up (p=0.002). Mean HbA1C at baseline was 105 mmol/mol, following referral, this improved to 90 mmol/mol (p<0.001).
Conclusions: Significant clinical benefit was achieved, particularly for Māori and Pasifika patients, thereby helping to address inequities in healthcare delivery. The care coordinator is now a vital part of the service, and several primary and secondary care providers have adopted the concept.
Biography:
Dr Ole Schmiedel is a consultant in endocrinology, diabetes, and general internal medicine at Auckland District Health Board (ADHB) and the Service Clinical Director of the Auckland Diabetes Centre. He qualified in medicine from Humboldt University in Berlin and completed his postgraduate training in diabetes and endocrinology at Cardiff University in Wales. He was awarded his MD for work in diabetes and microvascular complications. His main clinical and research interests are in the management of diabetes, obesity, and obesity-related complications. He is involved in education, training, and service development projects with a strong focus on supporting primary care teams.
Leaisa Bartley is New Zealand-born Samoan from the villages of Vao’to and Falea’puna. She completed Bachelor of Health Science at Auckland University of Technology before accepting her role as Care Coordinator at Auckland Diabetes Centre, Health New Zealand. Her role involves supporting high risk diabetes population access and navigate the complexity of health systems. She was invited to speak on improving patient engagement at Ministry of Health Diabetes Network (2019) and the New Zealand Society for the Study of Diabetes (2021). Leaisa is passionate about supporting vulnerable communities with diabetes and leading initiatives that improve Māori and Pasifika health outcomes.