Integrating Community Care for the Prevention and Treatment of Diabetes

Abstract

Introduction: This paper describes 'Project 8', a campaign that aims to reduce glycated haemoglobin (HbA1c) to 8% or more among patients with diabetes mellitus, utilising healthcare professionals and local community residents and focusing on education and support. The study is based in Uonuma-a small rural city in Japan with a declining population and an increased number of older people.

Description: 'Project 8' began in Uonuma's Koide Hospital in 2008. The Uonuma School for Community Health and Social Care was established in 2011 with the cooperation of a clinic's general practitioner. Medical students, trainees, doctors, and health care professionals have been holding 'open schools' (daytime lectures) and 'night schools' (evening lectures) to educate the community residents about various health issues. Through repeated lectures, the residents have been made aware of lifestyle-related diseases, including diabetes, and the meaning of 'Project 8'.

Discussion: Over the last decade, the hospital's campaign has expanded within the community, showing a statistically significant reduction of diabetic patients with HbA1c ≥ 8%, which successfully deferred the start of dialysis for many of them.

Conclusion: Well-integrated community care requires interprofessional education, collaborative practice, and the participation of community residents in health education.

Keywords: HbA1c; Project 8; community resident participation; integrating community care; interprofessional collaborative practice; interprofessional education.

Figure 1

Comparison of HbA1c values (total and those ≥ 8.0%) before and after the start of Project 8 and the Uonuma School for Community Health and Social Care. The blue bars depict the total number of HbA1c tests in the Koide Hospital annually from 2005 to 2020. The brown bars depict HbA1c ≥ 8.0% patients. The annual percentages of HbA1c ≥ 8.0% patients for the entire exam are illustrated as a line graph. All values from the Japan Diabetes Society (JDS) units from 2005 to 2011 were converted to National Glycohemoglobin Standardization Program (NGSP) units after 2012. P8 began in 2008, and the Uonuma School for Community Health and Social Care started in 2011.

Figure 2

Comparison of mean HbA1c every three to four years before and after the start of Project 8 and the Uonuma School for Community Health and Social Care. The X-axis denotes the stage duration (three to four years); the Y-axis denotes HbA1c (%, NGSP). Mean HbA1c every three to four years during 2005–2020 were compared. Stage B, from 2005 to 2007, indicates a period without IPCP. Stage A1, from 2008 to 2010, designates the period of IPCP within the hospital, as well as IPCP between a clinic and a hospital, aiming for HbA1c of less than 8.0%. Stage A2, from 2011 to 2013, shows the period of IPCP within the hospital, and between a clinic and a hospital, and community-resident participation, following commencement of the Uonuma School. Stage A3, from 2014 to 2016, refers to the period when staff became cognizant of the hospital’s specialisation in the management of chronic illnesses in primary care after the reorganisation of hospitals in the Uonuma area in 2015. Stage A4, from 2017 to 2020, is the period when guidelines for diabetes mellitus published in 2017 allowed for the maintenance of slightly higher HbA1c in older adults. A one-way ANOVA test, post hoc test, and t-test with Bonferroni correction were applied to compare all of the integrated criteria. Statistical significance was set as p < 0.05 and p < 0.01. R version 3.6.2 (The R Foundation for Statistical Computing, Austria) was used for all statistical analyses.

Figure 3

Comparison of HbA1c ≥ 8.0% before and after the start of Project 8 and the Uonuma School for Community Health and Social Care. The HbA1c ≥ 8.0% group was compared every three to four years, from 2005 to 2020. The classification of stages from 2005 to 2020 is the same as in Figure 2. A chi-square test, post hoc test, and Ryan’s multiple comparison were applied to compare all integrated criteria. * p < 0.05 and ** p < 0.01 were considered statistically significant. R version 3.6.2 (The R Foundation for Statistical Computing, Austria) was used for all statistical analyses.