Management of Type 2 Diabetes in General Practice in Ireland: effect of the ‘Cycle of Care’ Programme

Conference: 
SAPC ASM 2019 - Exeter
Talk Code: 
P1.02
Presenter: 
Raymond O'Connor
Co-authors: 
Jane O'Doherty, Ailish Hannigan, Aoife O'Neill, Conor Teljeur, Andrew O'Regan, Rory O'Driscoll
Author institutions: 
University of Limerick Graduate Entry Medical School, University of Limerick Dept of Mathematics and Statistics, Health Ireland User Group, Health Information and Quality Authority

Problem

Diabetes is a major cause of death and disability worldwide and is associated with complications, which are reduced by control of risk factors. The introduction of the diabetes ‘cycle of care’ pay for performance programme in Ireland in January 2016 means that general practitioners (GPs) have been resourced to provide structured care to patients with type 2 disease. The aim of this study was to examine the effectiveness of the ‘cycle of care’ programme

Approach

A computerised search was developed for diabetes data. 41 practices returned data for a 12 month period before (2014) and after (2017) the introduction of the ‘cycle of care’. International guidelines informed the analysis and categorisation of results. Comparison was made with results from similar audits conducted in Ireland (Midlands Diabetes Audit 2017) and United Kingdom (UK National Diabetes Audit 2015-6).

Findings

3189 patients were examined from 41 practices for the years 2014 and 2017. 9 practices were located in an urban setting (22%), 16 rural (39%) and 16 in a mixed location (39%). 1781 males (55.8%) and 1408 females (44.2%). In 2017, the mean age of participants was 68.5 (SD=12.3).2277 (71.4%) patients had clinical data provided for both 2017 and 2014, 875 (27.4%) for 2017 only, 5 (0.2%) for 2014 only and 32 (1.0%) for neither year. Substantial improvements in rates of recording and in levels of missing data were shown for HbA1c, lipids, renal function, blood pressure and BMI.Improvement was also seen in the standard of care as reflected in several of these results. Rates of foot review, retinopathy screening, treatment review, influenza immunisation and patient education were recorded for the first time in 2017 due to the programme.Results compared favourably with other Irish and UK data.

Consequences

This is the first study to examine the effect of the ‘cycle of care’ programme on the standard of care of people with type 2 diabetes in Irish general practice. This programme has resulted in substantial improvements in type 2 diabetes care in Ireland. These results strongly support ‘pay for performance’ measures to resource the management of chronic disease in Ireland.

Submitted by: 
Raymond O'Connor
Funding acknowledgement: 
Research and Education foundation of Irish College of General Practitioners, Dublin, Ireland.