HOW IT WORKS
This program serves patients with complex type 2 diabetes who also are dealing with nonmedical issues like poverty and lack of transportation. Because many diabetic outpatient services at local hospitals have long waiting lists, the Beacon program delivers services in a primary care setting, in cooperation with local hospitals’ endocrinology unit. The program improves access to specialized care delivered by general practitioners (GP) with advanced training in treating complex diabetes. Eligibility criteria for the program was guided by a random controlled trial (RCT) study protocol. Since the RCT was completed in 2017, Beacon’s model has been embedded in routine clinical practice. Enrollees receive an initial assessment from a diabetes nurse educator (DNE). The Beacon multidisciplinary clinic is held weekly with approximately 14 patients. DNEs working in the ambulatory Insulin Stabilization Service (ISS) program make phone calls to patients twice a week, supervised by GP Clinical Fellows. Patients in the ISS program have their DNE’s direct mobile number.
This program has served 1,500 patients since its launch in 2017. It recently expanded from a single site to three sites, treating the same population. The model has been extensively evaluated. Results of a study that compared operating costs of the Beacon clinic with hospital outpatient clinics put Beacon’s cost at $374 AUD per patient, compared to $415 AUD and $645 AUD at the comparison sites. Other assessments show that Beacon patients reported higher satisfaction with their care and better self-management support when compared to the previous model of care.
The referring GP is a key part of the care team and is recognized in all patient care plan summaries. The GP is also the link to the patient’s broader community care team, comprising a dietician, psychologist, social worker, and medical specialists, as required. Because Beacon relies on colocation, co-consultation and care coordination, it minimizes the need for transitions across care settings. There is active communication with the patient’s regular GP throughout the treatment cycle. After a patient’s discharge, GPs are advised to continue the usual cycle of care and are given guidance about conditions for re-referral.
Patients are empowered to manage their condition by a complex, effective set of interpersonal relationships and a supportive clinical team. They are provided with clear instructions about how to self-manage diabetes. This includes establishment of a routine and an emphasis on record-keeping, including entering results of their blood-sugar home monitoring in a record book.
The Beacon Clinic Steering Committee includes representation from a variety of health, health system, and hospital stakeholders and community service representatives. It meets twice yearly to review Beacon performance and benchmarking.
The model is financed through existing sources, with some additional infrastructure support sought for quality assurance and data collection. Endocrinologists and DNEs are funded by the hospital, which receives activity-based funding from the state government for the program. GPs with advanced training are funded separately. There is no patient payment.