Multi-disciplinary team care: patient or provider preference? — ASN Events
  1. Schedule
  2. ADS Clinical Orals - Type 1
  3. Multi-disciplinary team care: patient or provider preference?

Multi-disciplinary team care: patient or provider preference? (#165)

Janice Wiley 1 , Jerry Greenfield 2 , Ric Day 3 , Jeffrey Braithwaite 4
  1. Australian Institute of Health Innovation, UNSW, Sydney, Australia
  2. Garvan Institute, Sydney, NSW, Australia
  3. St Vincent's Hospital Clinical School, UNSW, Sydney, Australia
  4. Australian Institute of Health Innovation, UNSW, Sydney, Australia

OBJECTIVES
Attrition rates for young Australian adults with Type 1 Diabetes (T1D) from health services are reported as being around 50%. The multi-disciplinary diabetes team model is considered optimum care. We wanted to assess whether adults with T1D prefer this model. We examined the preferences of young Australian adults with T1D for consultation with multi-disciplinary diabetes team clinicians.
METHODS
We designed an online, self-reported, retrospective survey for Australian adults 18-35 years with T1D. Participants were recruited from advertisements with diabetes consumer-organizations. Respondents were questioned about their preferences to consult with multi-disciplinary team clinicians. To expand on the results of the questionnaire, respondents participated in focus groups and in-depth interviews.
RESULTS
Quantitative: n=150. Respondents consulted with the following clinicians: Endocrinologist only: 18%; endocrinologist and diabetes educator: 22%; endocrinologist, diabetes educator and dietitian: 14%; endocrinologist and general practitioner: 10.6%; endocrinologist, diabetes educator, dietitian, and psychologist/social-worker: 2%. 3% of respondents did not consult with any clinician.
Qualitative: n=36. Reasons why respondents did not consult with a multi-disciplinary team included: lack of opportunity to build a therapeutic relationship in an outpatient setting; failure of clinicians to engage in shared decision-making or to support self-management; inaccessibility of health services; failure of treating clinician to refer to other clinicians. Patient preferences were for clinicians who: practiced patient-centred care; undertook joint consultations with multi-disciplinary team members; provided flexible access to advice by email or telephone consultation.
CONCLUSIONS
Our results suggest that multi-disciplinary team care is not the preferred mode of care for young Australian adults with T1D. Given the low health service uptake and poor health outcomes of young adults with T1D, our results provide evidence for the potential value of patient engagement in health service re-design and have implications for improved health service delivery and improved treatment outcomes.