The Efficacy of Primary and Tertiary Specialist Care Collaboration and Mobile Complications Screening for Improving the Management of Diabetes at Primary Health Care Level in Tshwane District - A Cluster Randomized Trial

Diabetes Mellitus (DM) is a major metabolic disease that is characterised by a reduced or impaired capability of the body to regulate its blood glucose levels. The disease is now reaching pandemic levels. The global prevalence for DM (across all age groups) was estimated to be 2,8% in 2000, and it will rise to 4,4% by 2030. In real numbers this implies from 171 million people to 366 million people will be affected globally. This rise will certainly have an impact of the health care system of many countries. Most of the DM patients will be managed at primary health care level.

It has become clear that the difficulties in achieving a satisfactory level of health care delivery for DM patients are not related to the availability of knowledge of the disease, nor the best diagnostic and therapeutic procedures, but rather to system and organisational problems. Many of the complications of diabetes are potentially preventable or can be minimized if earlier action has been taken. The chronic nature of the disease and the need for the empowerment of the patient and the health workers in understanding the disease to ensure optimal glucose control makes DM an ideal disease to test new models of health care delivery which can include patient empowerment, health worker empowerment and the use of telemedicine and E-Health .

It is believed that the current primary health care approach is not allowing for sufficient time and personnel to provide patients with optimal care and to screen for diabetic complications. Currently only the blood pressure and random blood glucose measures are taken at Primary Health Care (PHC) facilities, even though the national policy for the management of diabetes prescribes the monitoring of complications at least once a year.

This study investigates the benefits of a comprehensive mobile screening effort to identify and to improve the early detection of diabetes-related complications. With the expected improvement in disease management and patient specific outcomes, this study will contribute to policy changes for diabetes management at primary health care level.

This study differs from other studies that evaluated complications in isolation. It aims to evaluate the efficacy of a complex intervention that provides an interface for Specialist from Family Medicine and Internal Medicine to collaborate and includes a mobile comprehensive complication screening service. The study also provides opportunity for training of clinic staff as well exposure and training of Clinical Associates regarding diabetes care and complication screening and management. It is envisaged that the structured screening and review programme will provide evidence for ways to ensure future collaboration enhancing diabetes patient outcomes.