Exploring the Impact and Value of Collaborative Care Model in Diabetes Care at a Primary Healthcare Setting In Qatar

Abstract

Background: Diabetes mellitus (DM) is one of the top health priorities in Qatar due to its high prevalence and negative health consequences. The current prevalence of DM in Qatar is 15.5%, which is projected to increase to 29.7% by 2035. DM management is still challenging despite healthcare advancement, warranting the need for a comprehensive Collaborative Care Model (CCM). In an effort to deliver comprehensive and integrated patient-centered healthcare services in the community, the government of Qatar focuses on primary care. Therefore, we aim to evaluate the impact and value of CCM in DM care at a primary healthcare (PHC) setting in Qatar.

Methodology: Phase I of this project was a multiple-time series, retrospective, observational study with a control group among patients with DM who received care at Qatar Petroleum Diabetes Clinic (QPDC) in Dukhan. The impact of CCM on glycemic control, blood pressure, lipid profile, and anthropometric parameters was evaluated at baseline and up to 17 months of follow-up. Patients were retrospectively categorized as intervention group if they received CCM and appropriate follow-up (n = 168) or usual care if they did not receive CCM and appropriate follow-up (n = 86). Quantitative data were analyzed descriptively and inferentially using the Statistical Package for the Social Sciences software. Phase II was a qualitative exploration of healthcare professionals’ (HCPs’) and patients’ perspectives on the value of CCM provided at the center. Twelve patients and twelve HCPs participated in semi-structured one-to-one interviews. Qualitative data were analyzed and interpreted using a deductive coding thematic analysis process.

Results: Patients in the intervention and control groups had similar baseline sociodemographic and clinical characteristics. The provision of CCM resulted in statistically significant improvements (p<0.05) in mean values (baseline vs. 17 months) of glycated hemoglobin A1c (6.9% vs. 6.5%), random blood glucose (194 mg/dL vs. 141 mg/dL), low-density lipoprotein cholesterol (3.7 mmol/L vs. 2.8 mmol/L), total cholesterol (5.4 mmol/L vs. 4.3 mmol/L), weight (78.5 Kg vs. 77.9 Kg), and body mass index (30.4 Kg/m2 vs. 30.2 Kg/m2) over 17-months within the intervention group; whereas, no significant changes occurred within the control group. Similarly, the between group comparisons demonstrated the superiority of CCM over usual care in improving several clinical outcomes. The qualitative phase resulted in 14 different themes under the predefined domains: components of CCM (five themes), the impact of CCM (three themes), facilitators of CCM provision (three themes), and barriers of CCM provision (three themes). The majority of the participants indicated easy access to and communication with HCPs at QPDC. Participants appreciated the extra time spent with HCPs, frequent follow-up visits, and health education, which empowered them to self-manage DM. Generally, participants identified barriers and facilitators related to patients, HCPs, and healthcare system.Conclusion: The implementation of CCM in a PHC setting improved several DM-related clinical outcomes over a 17-month period. The providers and users of CCM had an overall positive perception and appreciation of this model in PHC settings. Barriers to CCM such as unpleasant attitude and undesirable attributes of HCPs and patients, unsupportive hospital system, and high workload must be addressed before implementing the model in other PHC settings.