The role of patient and practice factors in primary care-centred management of diabetes in Ireland.

Conference:

SAPC ASM 2016 - Dublin

Talk Code:

P1.12

Presenter:

Julie Barrett

Co-authors:

Fiona Riordan, Sheena M. McHugh, Katie Murphy, Colin P. Bradley, Diarmuid Quinlan, Patricia M. Kearney

Author institutions:

Department of Epidemiology and Public Health, University College Cork; Department of General Practice, University College Cork; Diabetes in General Practice (DiGP) Ltd., University College Cork.

Problem

In recent years, the rising prevalence of diagnosed diabetes among Irish adults (from 2.2% in 1998 to 5.2% in 2015) has driven the reorientation of care from episodic management in secondary care towards more primary care-centred management. This has led to policy changes, including financial remuneration, for the management of stable Type 2 diabetes in general practice. Although primary care management has been associated with improved outcomes for patients with diabetes, the key factors associated with the quality of care in this setting have not been determined. Despite previous studies which have examined patient and practice level factors associated with patient outcomes, there is limited research in the Irish context. The aim of this study is to identify which patient and practice level factors are associated with high quality diabetes care in Ireland.

Approach

Data were collected in 2009/2010 from 28 practices (100 GPs and 55 Practice Nurses, PN) involved in the Diabetes in General Practice (DiGP) initiative, to improve the management of diabetes in primary care, in the South of Ireland. Data sources included clinical notes, referral letters and outpatient appointments in hospitals. Regression analysis will be used to examine the association of patient (age; gender; General Medical Services (GMS) status; diabetes type) and practice (number of GPs and PNs per practice; gender of the lead GP; access to retinopathy, podiatry and dietetic services; number of diabetic patients per practice) factors with patient outcomes (HbA1c, blood pressure, cholesterol, and triglycerides).

Findings

Data are available from 3,129 patients; 56% male (n = 1765), 74% with a GMS card (n = 2,326), entitling them to free GP care. The majority have Type 2 diabetes (T2DM) (n = 2,488, 79%). Lead GPs are predominately male (n = 20, 71%). All 28 practices are computerised. The number of GPs ranges from 1 to 10 per practice (mean = 3.57; s.d. = 1.81), with only 1 single-handed practice; PNs from 1 to 5 per practice (mean = 1.96; s.d. = 1.11). Most practices have access to retinopathy screening (n = 28, 100%); podiatry services (n = 27, 96%); and dietetics (n = 26, 93%). The mean number of patients with diabetes per GP across practices is 106.85 (s.d. = 55.70). Among patients with T2DM, 36% (n = 764) have a HbA1c <6.5%; 37% (n = 826) have a blood pressure ≤130/80mmHg; 65% (n = 1425) have a total cholesterol of <4.5mmol/l; and 68% (n = 1224) achieve triglycerides targets of <2.0mmol/L.

Consequences

Further work will be carried out to determine how differences in the patient and practice characteristics are associated with patient outcomes. These findings will provide an insight into key factors involved in optimal diabetes primary care management in Ireland.

Submitted by:

Julie Barrett

Funding acknowledgement:

The research is funded by the HRB Research Leader award, as part of the work on Improving Care for People with Diabetes: A Population Approach to Prevention and Control.