Effectiveness of a Patient-Centre Medical Home model on diabetes and other clinically relevant outcomes among primary care patients diagnosed with type-2 diabetes in Sydney, Australia

Abstract

Aim: We aim to evaluate the effectiveness of patient-centred medical home (PCMH) model in improving diabetes and clinical outcomes among primary care patients diagnosed with T2D.

Methods: The WellNet study used cohort design with a concurrent comparison group to evaluate changes in clinical outcomes across six general practices in Sydney, Australia. The treatment group comprised of 279 patients who received PCMH care whereas the matched comparison group included 3671 patients who received standard care. t-tests with analysis of covariance were conducted to evaluate significant mean differences and multivariate logistic regression was performed to determine predictors of glycaemic control at follow-up.

Results: WellNet patients observed slightly larger within-group mean differences compared to comparison group patients (-0.2% vs -0.04%). Additionally, WellNet patients saw a larger increase in the percentage of patients achieving glycaemic control (7.9% vs 2.3%). A statistically significant mean difference was seen in waist circumference after adjusting for covariates (-2.41 cm, 95% CI -4.72 to -0.11; p < 0.05). Findings of multivariate logistic regression analysis showed that withdrawn patients and elevated HbA1c measures at baseline were associated with poor glycaemic control at follow-up.

Conclusion: The study findings may be beneficial to patients in terms of improved clinical outcomes and self-management support.

Keywords: Chronic care model; Diabetes self-management; HbA1c; Patient-centred medical home; Primary care; Type 2 diabetes.