Shared care in diabetes

Better evaluation is needed

Interest is increasing in the greater integration of primary and secondary health care,1 and purchasers are exerting pressure to shift patients from secondary to primary care, partly for financial reasons and often regardless of effectiveness. Examples of such integration in managing chronic diseases are schemes of “shared” or “integrated” care—for example, for patients with diabetes, asthma, or hypertension. Such schemes are loosely characterised by joint participation of hospital consultants and general practitioners in the planned delivery of care and an enhanced exchange of information over and above routine discharge and referral letters.2

Despite the growing enthusiasm for these schemes, they have not yet received sufficient critical evaluation to justify national adoption. This has been recognised by the NHS research and development initiative, which has identified shared care as a priority area for research.

Most research attention has been devoted to shared care for patients with diabetes, and this has recently been the subject of an extensive literature review.3 This review identified five randomised controlled trials and several other comparative, longitudinal, and descriptive accounts …