A comparison, for older people with diabetes, of health and health care utilisation in two different health systems on the island of Ireland

Abstract

Background Primary care policies for diabetes have differed between Northern Ireland (NI) and the Republic of Ireland (ROI). In NI, the Quality and Outcomes Framework (QOF) system was adopted in 2004. In ROI, prior to the Cycle of Care programme being established in 2015 specific financial support for GPs providing diabetic primary care was not available. The aims of this study are to compare health and healthcare utilisation among people with diabetes in the NI and ROI.Methods Large scale comparable surveys of people over 50 years of age in Northern Ireland (NICOLA) and the Republic of Ireland (TILDA) are used to compare people with diabetes (Type I and Type II) in the two jurisdictions. The combined data set comprises 1,536 people with diabetes. A coarsened exact matching approach is used to compare health care utilisation among people with diabetes in NI and ROI with equivalent demographic, lifestyle and illness characteristics. ResultsThe overall prevalence in the 50 to 84 years old age group is 3.4 percentage points higher in NI (11.1% in NI, 7.7% ROI, p-value < 0.01). The diabetic population in NI also appear sicker -with more diabetic complications and more chronic illnesses. Comparing people with diabetes in the two jurisdictions with similar levels of illness we find that there are no statistically significant differences in GP, outpatient or A&E utilisation.Conclusion There are a range of factors that influence the quality of primary care for people with diabetes. While the QOF system in Northern Ireland is likely to have improved some aspects of care by providing financial incentives for identification and management, unless accompanied by improved access to care their ability to impact on outcomes may be compromised. 4.Nolan J, O'Halloran D, McKenna T, Firth R, Redmond S. The cost of treating type 2 diabetes (CODEIRE). Irish medical journal. 2006;99(10):307-10. 5. Kanavos P, Aardweg Svd, Schurer W. Diabetes expenditure, burden of disease and management in 5 EU countries. LSE Health, London School of Economics, 2012. 6. Read SH, Kerssens JJ, McAllister DA, Colhoun HM, Fischbacher CM, Lindsay RS, et al. Trends in type 2 diabetes incidence and mortality in Scotland between 2004 and 2013. Diabetologia. 2016;59(10):2106-13. 7. Hex N, Bartlett C, Wright D, Taylor M, Varley D. Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, including direct health costs and indirect societal and productivity costs. Diabetic Medicine. 2012;29(7):855-62. 8. Sortsoe C, Green A, Jensen PB, Emneus M. Societal costs of diabetes mellitus in Denmark. Diabetic Medicine. 2016;33(7):877-85. 9. Maghbooli Z, Pasalar P, Keshtkar A, Farzadfar F, Larijani B. Predictive factors of diabetic complications: a possible link between family history of diabetes and diabetic retinopathy. Journal of Diabetes & Metabolic Disorders. 2014;13(1):55. 10. Zoungas S, Woodward M, Li Q, Cooper ME, Hamet P, Harrap S, et al. Impact of age, age at diagnosis and duration of diabetes on the risk of macrovascular and microvascula...

A simulation study of the economic and health impact of a diabetes prevention programme in Ireland

“…The specified range for the number of cases of pre‐diabetes was sourced from a nationally representative survey carried out in 2007 7 . The specified range for the number of cases of diabetes, and the proportion of these with a complication related to diabetes, was sourced from a nationally representative survey of people over 50 years of age (TILDA) carried out in 2010/2011 26 . The 95% confidence intervals of prevalence estimates from these studies were used to calculate a range of estimates of diabetes and pre‐diabetes for the study year.…”

“…No country to date has reversed its obesity epidemic, 3 and Ireland is no exception with the percentage of adults who are obese increasing from 10% in 1998 to 23% in 2018 4,5 . There are limited current or historic data available on the epidemiology of diabetes in Ireland 6‐8 . Ireland does not have a national diabetes register, the epidemiological data available being based on a number of representative surveys undertaken at various time points.…”