Intervention:

Standard care was observed, knowledge was measured. An ICP for PWD was implemented June 2014 for use by the multidisciplinary inpatient team. ICP guides health professionals to appropriately educate, and empower PWD to better self-manage diabetes at home.

 

Primary outcome: improve HbA1c 3 months post-discharge.

Secondary outcomes: reduce hospital LOS, 30 day readmissions, promote communication/knowledge.

 

Findings:

31 PWD standard-care, 16 in ICP  

 

HbA1c:            At 3 months HbA1c standard-care improved to 73.1mmol/mol (-7.9mmol/mol, 9.8% improvement) versus ICP 81.8mmol/mol (-8.5mmol/mol, 9.4% improvement).

 

LOS:    Average standard-care 5.48 days versus ICP 5.31 days.

 

30 Day Readmissions: 32.3% of standard-care PWD experienced readmission within 30 days of discharge, versus 18.8% in ICP. Readmissions were not primarily for diabetes.

 

Post-Trial Staff Questionnaires: Staff gave a higher rating pre-trial/showed greater knowledge, compared to post-trial for:

            Confidence caring for PWD

            Nursing/doctors/pharmacists/dietitians share responsibility for ensuring patients are prepared for discharge

            Providing medication education

            Providing information about hypoglycaemia

            Prescription at discharge

            Referrals to post discharge care

 

Standard-Care patients were more likely to:

            Have an acceptable plan of care (93.5% vs 85.7%)

            Be given a discharge summary (90.3% vs 87.5%)

            Be given a prescription at discharge (100% vs 92.9%)

            Feel confident to self-manage at home (90.3% vs 85.7%)

 

ICP patients were more likely to:

            Have their prescription dispensed (76.9% vs 35.5%)

            Continue using insulin (100% vs 83.3%).

            Have a glucose meter (92.9% vs 87%).

            Have test strips (92.9% vs 83.8%).

            Identify diet and weight as factors in controlling diabetes in addition to medications

 

 Potential Use:

ICP may be an effective way to promote shared responsibility by health professionals caring for PWD in partnership, as patients acquire knowledge and resources for self-management.