Counting on commitment; the quality of primary care-led diabetes management in a system with minimal incentives

Abstract

BackgroundThe aim of the present study was to assess the performance of three primary care-led initiatives providing structured care to patients with Type 2 diabetes in Ireland, a country with minimal incentives to promote the quality of care.MethodsData, from three primary care initiatives, were available for 3010 adult patients with Type 2 diabetes. Results were benchmarked against the national guidelines for the management of Type 2 diabetes in the community and results from the National Diabetes Audit (NDA) for England (2008/2009) and the Scottish Diabetes Survey (2009).ResultsThe recording of clinical processes of care was similar to results in the UK however the recording of lifestyle factors was markedly lower. Recording of HbA1c, blood pressure and lipids exceeded 85%. Recording of retinopathy screening (71%) was also comparable to England (77%) and Scotland (90%). Only 63% of patients had smoking status recorded compared to 99% in Scotland while 70% had BMI recorded compared to 89% in England. A similar proportion of patients in this initiative and the UK achieved clinical targets. Thirty-five percent of patients achieved a target HbA1c of < 6.5% (< 48 mmol/mol) compared to 25% in England. Applying the NICE target for blood pressure (≤ 140/80 mmHg), 54% of patients reached this target comparable to 60% in England. Slightly less patients were categorised as obese (> 30 kg/m2) in Ireland (50%, n = 1060) compared to Scotland (54%).ConclusionsThis study has demonstrated what can be achieved by proactive and interested health professionals in the absence of national infrastructure to support high quality diabetes care. The quality of primary care-led diabetes management in the three initiatives studied appears broadly consistent with results from the UK with the exception of recording lifestyle factors. The challenge facing health systems is to establish quality assurance a responsibility for all health care professionals rather than the subject of special interest for a few.

Impact of two different health systems on the burden of type 2 diabetes

“…13 In the UK NHS, these aspects of care are all either directly or indirectly incentivized under the QOF and have all been shown to have improved in the UK since the introduction of the QOF in 2004. 28 McHugh et al 14 assessed the performance of three primary care-led initiatives in small geographic areas of ROI, and, although they did not compare the overall quality of diabetes care in ROI, the study highlighted the comparable levels of process measures of performance found in selected areas with a structured system of diabetes care, despite the lack of any financial incentives.…”

Barriers to, and facilitators in, introducing integrated diabetes care in Ireland: a qualitative study of views in general practice

“…Those who are not eligible must pay to attend the GP. In terms of diabetes care, at present there are a variety of care arrangements in place across the country including traditional hospital-based management, shared care between general practitioners (GPs) and hospitals, primary care-led management 8 9 and unstructured opportunistic care. The most recent survey of diabetes management in general practice highlighted the lack of formal integration between settings 10.…”

Práticas avançadas no cuidado integral de enfermagem a pessoas com úlceras cutâneas

“…Such care must be exercised with competence and technical specificity of the skin, requiring the nursing consultation to perform comprehensive, effective therapy that promotes the best practice in the area of skin health care. (23,25,26) In fact, nursing consultations allow an interpersonal interaction that stimulates the adoption of care for the metabolic control and treatment of chronic injuries. In this case, the consultations demand high therapeutic acuity and technical specificity, determinants for comfort, confidence, decrease of pain, case resolution and greater clinical adhesion.…”

“…In a follow-up study of 185 people with diabetes who underwent intensive follow-up and education on the prevention of complications for two years, there was a significant reduction in the incidence of wounds higher healing rates, and fewer surgical interventions. (25) Health recovery can be achieved if there is a service network with professionals engaged, especially with primary care as the gateway to the system with a focus on health promotion and protection. (25) Presence of venous injuries that are of long duration and high rates of relapse, have affected more women and have average time greater than four years.…”

“…(25) Health recovery can be achieved if there is a service network with professionals engaged, especially with primary care as the gateway to the system with a focus on health promotion and protection. (25) Presence of venous injuries that are of long duration and high rates of relapse, have affected more women and have average time greater than four years. Studies estimate that approximately 1.5 to 3% of the adult population worldwide have active venous injuries, which leads to loss of quality of life, pain, psychosocial suffering and limitation in work.…”