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Interventions developed to reduce secondary care utilisation in patients with type 2 diabetes mellitus: a narrative review

Khayyat, Sarah M; Walters, Philippa A; Whittlesea, Cate; Nazar, Hamde; (2022) Interventions developed to reduce secondary care utilisation in patients with type 2 diabetes mellitus: a narrative review. International Journal of Pharmacy Practice , 30 (2) pp. 116-128. 10.1093/ijpp/riac009. Green open access

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Abstract

OBJECTIVES: To identify, describe and critically appraise the quality of studies of interventions developed to reduce the rate of secondary care utilisation and investigate interventions' impact on patients with type 2 diabetes mellitus (T2DM). METHOD: Using a systematic approach, five databases were searched between 01 January 1995 and 01 February 2021 (MEDLINE, EMBASE, PsycINFO, CINAHL and Cochrane database). Inclusion criteria were studies (published in English) in adults with T2DM offered intervention(s) involving medicines/services/educational programmes in any country or setting, with investigated outcomes including the rate of hospital admission/re-admission/accident and emergency visits. Validated tools were used to assess the quality and accuracy of reporting the interventions. A narrative synthesis was used to frame the findings. KEY FINDINGS: A total of 4670 papers were identified, which yielded a final 53 studies after screening against the inclusion criteria. Identified interventions were complex interventions (n = 21) including at least two interventions (e.g. improving medication adherence and patient education), medication management (n = 15), patient education programmes (n = 8), lifestyle interventions (n = 5) and other interventions (n = 4; e.g. dental care). After assessing for quality and effectiveness of interventions, 15 studies remained; 7 were medication management interventions (e.g. use of insulin pen) and 8 were complex interventions (e.g. pharmaceutical care and telehealth systems). Complex interventions showed significant improvement in clinical outcomes and reduction in secondary care utilisation. CONCLUSIONS: This narrative review identified potential elements of an effective complex intervention to reduce healthcare utilisation in patients with T2DM. These results could inform the development of interventions to be tested for feasibility, before piloting to assess for outcomes that improve diabetic care, reduce diabetes-related complications and minimise healthcare utilisation.

Type: Article
Title: Interventions developed to reduce secondary care utilisation in patients with type 2 diabetes mellitus: a narrative review
Location: England
Open access status: An open access version is available from UCL Discovery
DOI: 10.1093/ijpp/riac009
Publisher version: https://doi.org/10.1093/ijpp/riac009
Language: English
Additional information: This version is the author accepted manuscript. For information on re-use, please refer to the publisher’s terms and conditions.
Keywords: accident and emergency visit, hospital admission, hospital re-admission, secondary care utilisation, type 2 diabetes mellitus
UCL classification: UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy > Practice and Policy
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences
UCL
UCL > Provost and Vice Provost Offices > School of Life and Medical Sciences > Faculty of Life Sciences > UCL School of Pharmacy
URI: https://discovery.ucl.ac.uk/id/eprint/10147666
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