Implementing Specialized Diabetes Teams in Primary Care in Southern Ontario

Abstract

Objectives: This study explores the implementation processes of integrating specialized diabetes teams into primary care in southern Ontario, Canada.

Methods: In-depth qualitative interviews were conducted with 23 patients, 20 diabetes educators and 16 primary care physicians. In addition, group debriefing sessions were conducted and field notes were collected from diabetes educators and diabetes education program managers to further explore the day-to-day issues of implementation. Data were analyzed using an inductive content analysis approach.

Results: Analysis revealed 3 main themes: Right Place, Right Time, Right Service: the convenience and comfort of local care, timely, preventive management and delivering person-centred care; Creating Partnerships: generating intervention buy-in, formal discussion, service agreements, site orientation and team development; Operational Complexities and Strategies: access to electronic medical records and documentation, referral and scheduling procedures, and costs and resources.

Conclusions: Because situating diabetes teams in primary care currently involves using existing healthcare structures and human resources, pragmatic methods of fostering successful implementation of this model of practice are required. The utility of this model was perceived as being viable, and benefits were visible to all study participants. Strategies to facilitate implementation include outlining roles and expectations by educators and the primary care providers' team in the beginning, investment in the intervention by all stakeholders, and clear channels of communication that allow educators to perform their roles and leverage opportunities for team collaboration in patient care. Further evaluation of implementation processes can serve to expand this model of practice, which has proven so far to be favourable to the players involved.

Keywords: Collaboration interprofessionnelle; Diabetes care; Diabetes educators; Enseignement sur la prise en charge autonome; Implementation; Interprofessional collaboration; Intégration des services; Mise en œuvre; Patient services; Primary care; Self-management education; Service integration; Services aux patients; Soins aux diabétiques; Soins de santé primaires; Soins spécialisés; Specialized care; Éducateurs en diabète.