Moncton, NB (NBHC) – The New Brunswick Health Council (NBHC) is releasing its first report which evaluates and identifies effective practices designed to improve health service quality and outcomes in New Brunswick’s diabetes clinics. This will help inform the Department of Health’s and the Regional Health Authorities’ efforts to improve the quality of diabetes-related health services as it relates to the Comprehensive Diabetes Strategy.
In June 2012, the NBHC began a project in partnership with the Department of Health to assess the delivery of services for patients with diabetes in the province. Thirty-seven different points of services were identified for enhanced diabetes education and care. Two key findings were that more human resources were not necessarily related to better outcomes, and that the most efficient and effective clinics were those that built the care around the patient. Large diabetes clinic costs varied from $33 to $158 per visit, yet the clinic with the lowest cost per visit actually had the highest proportion of diabetes patients achieving control of blood sugar levels (A1c level between 6% and 8%).
- Geographic distribution: Zone 4 (Madawaska/North-West Area) and Zone 6 (Bathurst/Acadian Peninsula Area) have the highest proportion of patients reaching A1c target levels.
- 80% benchmark: For a patient with diabetes, a target level of less than 7% is generally recommended, although in some cases an A1c of up to 8% is acceptable. Results show it is possible to get 80% of diabetes patients achieving an A1c level between 6% and 8% (six clinics were between 75% and 80%). This value could be a realistic benchmark of good performance for any clinic or primary care provider.
- Being patient-centered: This includes providing good accessibility and flexibility in the offering of services, as well as establishing and maintaining strong links with primary care providers, other health services and community resources to enhance integration and coordination.
"Programs and services are developed to achieve certain outcomes. Being able to measure if they are delivering on these outcomes is the ultimate value for all New Brunswickers, no matter their individual characteristics, circumstances or geographic location," says Stéphane Robichaud, CEO of the NBHC. "Learning from the better performers can help promote better practices aimed at improving quality of services, improving outcomes and reducing the overall burden and future costs to the health system."
Other key findings include:
- Diabetes clinics have a positive impact on patients: Patients attending clinics achieve larger reductions in A1c levels within a two-year period compared to those who do not attend clinics. These clinics appear to achieve larger reductions in blood sugar levels in the lowest (< 8%) and highest A1c categories (> 9%). Attending clinics earlier in the disease may be important in reducing the burden of a chronic disease. Our evaluation showed that hospital admissions were reduced by 50% the year after the diabetes patient made their first clinic visit. More study would be valuable to assess this type of impact on a much longer term basis.
- There is a need throughout New Brunswick for more systematic quality improvement programs: Only one clinic mentioned having a systematic quality improvement program. Most clinics were unable to define outcomes in terms of their patient population.
- Patient illiteracy and poverty are obstacles for some diabetes clinics: Education tools are hard to come by for illiterate patients. Poverty was also often linked to food insecurity and lower intake of fruits and vegetables, as well as to a lack of access to medical supplies and devices.
- The lack of patient record integration between the two RHAs can affect clinics’ ability to care for patients: One clinic, located on the border between a Vitalité zone and a Horizon zone, noted it had no access to patient records in the other health network, preventing it from properly treating its patients.
The complete report, Evaluation of the Effectiveness of Diabetes Education Centres Across the Province of New Brunswick, is available online at nbhc.ca
The NBHC has been established as an independent organization that measures, monitors and evaluates New Brunswick’s health care system performance and population health, and that engages citizens in the improvement of health service quality.
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