A 'radical' new rural model for pediatric diabetes care.

摘要

OBJECTIVE: The purpose of the study was to evaluate a new rural Australian multidisciplinary model of pediatric diabetes care. METHODS: In 2007, in response to insurmountable obstructions to establish an effective multidisciplinary team within the public health system, an Australian rural pediatric practice created a private multidisciplinary diabetes care model. The 'Rural Australian Diabetes -Inspiring Control Activity & Lifestyle' model -'RADICAL'-comprised a locally based, co-located core team of general pediatrician, diabetes educator, and mental health nurse. Regular diabetes clinics were established, including team meetings where each individual patient was discussed. Therapy included proactive child and family emotional support and promotion of insulin regimes that aimed to match patient lifestyle, especially insulin pump therapy. By 2009, 56 of 61 children and adolescents with type 1 diabetes across a broad regional area had access to the model of care. The model was evaluated in terms of metabolic control, patient satisfaction, and quality of life. RESULTS: Since the RADICAL model was established, the average HbA1c has fallen from mean 9.6% +/- 1.81 (median 9.7%) in 2006 to mean 8.1% +/- 1.25 (median 7.9%) in 2009 (p < 0.001). Patient satisfaction with the model was overwhelming. The previously demonstrated reduced quality of life of Australian rural diabetic youth compared with urban diabetic youth was eliminated. CONCLUSION: Multidisciplinary child diabetes care can be successfully achieved in rural settings using local resources with results comparable to international tertiary multidisciplinary diabetes units.