Scoping Review of Diabetes Care in Ontario

Project Team:

Description of Project:

The Canadian Diabetes Association (CDA) (2016) estimates that 3.4 million Canadians are currently living with diabetes and that by the year 2025 the rates will increase to reach 5 million Canadians. In the province of Ontario, 862,868 people had diabetes in 2014, which accounted for more than one third of Canadians having the condition (Stats Canada, 2016). When managed properly, diabetes can have little impact on a person’s life. However, improper management can result in negative outcomes for an individual’s health and quality of life. There are many interventions that attempt to assist individuals in managing their diabetes and yet, rates of management targets for blood glucose levels, blood pressure and cholesterol are below recommended targets. Much of the literature takes into account individual or patient perspectives and how to improve outcomes by focusing on individual or patient-delivered interventions. There has been limited evidence focused on interventions provided by health care providers.

The purpose of this project was to determine what interventions, innovations, models, and quality improvement strategies were utilized in Ontario at the provider level to address gaps in care for individuals with diabetes.

A comprehensive search strategy was developed and executed. The initial search compiled 1029 citations, of which 46 articles were selected through an iterative process between 2 independent reviewers. Each article was analyzed and data extraction occurred with the use of a spreadsheet. Review of selected articles revealed themes categorized under the elements of the Chronic Care Model (CCM) as follows:

  1. A) Delivery Systems Design: The Team – Interprofessional Collaboration (IPC) and Team Composition
    B) Delivery Systems Design: Team RolesLeadership and Coaching
  2. Self-Management Support – Personalized Support
  3. Decision Support – Guideline Harmonization and Guideline Implementation
  4. Clinical Information Systems – E-Assessments, E-Delivery, E-Audit/Feedback, and E-Reminders
  5. Community – Partnering and Transitioning
  6. Health Systems – Incentives. A grey literature search of the topic was initiated and is also part of the report

Introducing interventions at the provider level have the potential to improve outcomes for individuals with diabetes. A multitude of provider interventions have been identified in this report and organized to highlight the delivery and organization of diabetes care in Ontario using the CCM. We anticipate that information contained in this report could be shared and utilized by providers to improve the planning and coordination of diabetes care. Importantly, information contained in this report reflects current provider interventions and a prototype to strengthen the delivery and organization of diabetes care in Ontario.

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