Mandatory, multidisciplinary education in diabetes care. Can it meet the needs of primary care organisations?
Authors: Hearnshaw Hilary , Hopkins Jan , Wild Andrea , MacKinnon Mary , Gadsby Roger , Dale Jeremy 
Published: August 2002

Objectives

To assess the effectiveness and feasibility of mandatory, multidisciplinary education, in the context of a primary care organisation service development programme for diabetes care. To identify any obstacles to change and to measure changes in knowledge, service organisation and attitudes after a university based course in diabetes care.

The course

It was mandated by the primary care group of Ladywood, Birmingham, UK, that one general practitioner and one nurse from each practice should attend a course in diabetes care, which comprised 30 hours spread over 3 months, with three pieces of assessed coursework and a written examination. The programme, led by a shared vision of committed local leaders, also included consultant‐led community diabetes clinics, shared software for all providers, and payment for minimum primary care standards.

Design

A longitudinal study of the first cohort of the course, using a questionnaire administered at the start of the course and repeated one year later.

Setting

Ladywood Primary Care Group, Birmingham, UK, comprising 38 practices in this area of high deprivation.

Main outcome measures

Comparison of the mean knowledge scores of 16 general practitioners and 12 nurses in relation to 68 diabetes‐related topics before the course and one year later. Measurement of changes in the organisation of diabetes care within practices during the year after the course. Views on the acceptability of mandatory, multidisciplinary education.

Results

There was a statistically significant increase in the mean knowledge scores of general practitioners (p≤0.01) and practice nurses (p≤0.01) over all topics. There were statistically significant changes in many organisational aspects of diabetes care within practices, for example the proportion undertaking annual reviews and having dedicated time for diabetes clinics. Several obstacles such as time and resources, both human and financial, were identified by participants as barriers to further change. The mandatory course was accepted by most participants. The experience of doctors and nurses learning together was regarded by some as an unexpected benefit of the course.

Conclusion

A defined need for education in primary diabetes care as part of a service development programme was met successfully by this course and found acceptable. There were measurable changes in the knowledge of health care professionals one year after the course. Improvements in the organisation of diabetes care were reported, which can be attributed to the whole programme, not only the course, although the usual obstacles to change were found. Future research is needed to identify the persistence of the changes and their presence in a larger sample and in other settings. A mandatory, multidisciplinary education might be usefully adopted by primary care organisations in their service development programmes. In particular this is relevant to the implementation of the UK national service framework for diabetes. Copyright © 2001 John Wiley & Sons, Ltd.