Testing co-produced solutions for service delivery redesign of primary care for people with diabetes.

Research Question: Will a co-produced redesigned care model based in primary care improve health system outcomes in people with diabetes?

Background: Strong primary health care saves lives, improves the efficiency of resource use, and makes health systems more resilient and effective for all. Type 2 Diabetes is an increasing global health burden. Argentina's primary care system is falling short in detecting and controlling diabetes, with many in treatment bypassing primary care for secondary facilities.

Poor disease control contributes to excess morbidity and mortality while increasing costs to individuals and the health care system. Service delivery redesign is a system-level framework for improving care delivery defined as the reorganisation and strengthening of existing services and care pathways to maximise quality care and optimise health outcome.

Based on a diagnostic process carried out in Mendoza province, and our established relationship with local policymakers and stakeholders, we propose to evaluate a multicomponent evidence-based redesigned care model and implementation strategy.

Aims and objectives: The overall aim is to refine and evaluate the effectiveness of a co-designed primary care model to improve health system performance for disease management and patient experience among individuals living with type 2 diabetes who rely on public health care. The primary objective is to improve disease control and care experience in patients with diabetes.

The secondary objectives are: a) to assess feasibility and acceptability of the model; b) to test the model’s impacts on service use patterns, system competence, user confidence, and cost per visit, and c) to analyse the impact of the model on potential inequalities by sociodemographic factors.

Methods: This is an efficient, parallel-arm cluster randomised controlled Hybrid Type 1 trial with 24 primary health care centres allocated 1:1 to control (usual care) or intervention. In Phase I, we will design, test, and refine a newly redesigned primary care model and implementation strategies. In Phase II, we will conduct the trial (9-month baseline data collection, 15-month intervention, and 6-month sustainability period).

Outcomes will be assessed using routine clinical records on all patients with diabetes at study facilities and a longitudinal cohort of N=480 patients. In Phase III, we will conduct analysis, reporting, and dissemination of findings, working with local policymakers to translate findings into policy.

Timelines for delivery: The study will last 36 months, with 3 overlapping phases to design, implement and evaluate the effect of the new care model.

Anticipated impact and dissemination: Dissemination activities and outputs will include writing and submitting manuscripts for publication, writing policy briefs to support strategy implementation in other regions or countries, and tailoring outputs for patients, clinicians, and researchers. We anticipate that improvement in disease management as well as patient experience will have clinical as well as economic benefits, related to reduced usage of secondary- and tertiary-level facilities, lower cost per visit, and a reduced number of clinical events related to diabetes.

On a bigger scale, this project constitutes one of the first experiences in service delivery redesign for NCDs and its findings will be informative for future work in this line of research and health policy all over the world with particular focus in LMICs.