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Geography does not limit optimal diabetes care: Use of a tertiary centre model of care in an outreach service for type 1 diabetes mellitus

Authors

  • Peter J Simm,

    Corresponding author
    1. Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
    2. Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
    • Correspondence: Dr Peter Simm, c/o Department of Endocrinology and Diabetes, The Royal Children's Hospital Melbourne, Flemington Road, Parkville,Vic. 3052, Australia. Fax: +61 3 9345 5922; email: peter.simm@rch.org.au

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  • Nicole Wong,

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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  • Lynne Fraser,

    1. Wimmera Health Care Group, Horsham, Victoria, Australia
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  • John Kearney,

    1. Western District Health Service, Hamilton, Victoria, Australia
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  • Judy Fenton,

    1. Portland and District Health Service, Portland, Victoria, Australia
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  • Kim Jachno,

    1. Clinical Epidemiology and Biostatistics Unit, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
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  • Fergus J Cameron

    1. Department of Endocrinology and Diabetes, Royal Children's Hospital Melbourne, Melbourne, Victoria, Australia
    2. Centre for Hormone Research, Murdoch Childrens Research Institute, Melbourne, Victoria, Australia
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  • Conflict of interest: The authors declare they have no conflicts in relation to this article.

Abstract

Aim

Young people with type 1 diabetes mellitus living in rural and regional Australia have previously been shown to have limited access to specialised diabetes services. The Royal Children's Hospital Melbourne has been running diabetes outreach clinics to Western Victoria, Australia, for over 13 years. We aim to evaluate this service by comparing the outcomes of three outreach clinics with our urban diabetes clinic at the Royal Children's Hospital Melbourne.

Methods

We examine our tertiary, multidisciplinary team-based model of care, where visiting specialist medical staff work alongside local allied health teams. The local teams provide interim care between clinics utilising the same protocols and treatment practices as the tertiary centre. Longitudinal data encapsulating the years 2005–2010, as a cohort study with a control group, are reviewed.

Results

A total of 69 rural patients were compared with 1387 metropolitan patients. Metabolic control was comparable, with no difference in mean HbA1c (8.3%/67 mmol/mol for both groups). Treatment options varied slightly at diagnosis, while insulin pump usage was comparable between treatment settings (20.3% rural compared with 27.6% urban, P = 0.19). Of note was that the number of visits per year was higher in the rural group (3.3 per year rural compared with 2.7 urban, P < 0.001).

Conclusions

We conclude that the outreach service is able to provide a comparable level of care when the urban model is translated to a rural setting. This model may be further able to be extrapolated to other geographic areas and also other chronic health conditions of childhood.

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