Differences in the process of diabetic care between south Asian and white patients in inner-city practices in Nottingham, UK

Abstract

The prevalence and complication rate of diabetes is higher amongst British south Asians when compared to the rest of the adult population. There is some evidence to suggest that there are differences in access to healthcare in the UK for different ethnic groups, but there has been little research examining differences in processes of care between ethnic groups and place of delivery of diabetic care. The present study was a retrospective, multi-practice audit exploring differences in the processes of diabetic care provided to white and south Asian patients. Data were obtained from eight practices located in deprived areas in Nottingham, UK. A review of the evidence-based protocols for the monitoring of diabetic care generated a list of process criteria to be measured. All primary care data sources were examined over a 12-month period by a single investigator. The data were analysed with respect to patient ethnicity and place of diabetic care after adjusting for confounders. Eight hundred and thirty-nine diabetic patients were included in the audit and 671 (80.0%) received a formal annual diabetic review. One hundred and five (12.5%) patients were classified as south Asian. They were significantly less likely to have their blood pressure [86% versus 89%, odds ratio (OR) = 0.62, 95% confidence interval (95% CI) = 0.54 -0.72] or serum creatinine (67% versus 76%, OR = 0.41, 95% CI = 0.32-0.52) measured when compared to white patients. Patients receiving shared care from a hospital-based diabetic team were more likely to have a range of items of the annual review recorded. When examined by ethnicity, south Asians receiving shared care were again less likely than white patients to have their blood pressure and serum creatinine measured. There was also some evidence that they may be less likely to have their body mass index recorded and their feet examined. The findings of the present study showed that, although most diabetic patients received a formal annual clinical review, scope for improvement remained. Shared care of patients with a hospital-based team produced better results when processes of care were examined. However, this benefit did not apply equally to south Asian and white patients. Further studies are indicated to confirm these results, which may have wider implications for the planning and provision of diabetic care.

Patient access to healthcare services and optimisation of self-management for ethnic minority populations living with diabetes: a systematic review

“…2002). There is further evidence that patients who report ethnic discrimination in their lives have a higher incidence of poor health (David & Kendrick 2004) and a far lower probability of receiving clinical monitoring tests (Ryan et al. 2008).…”

“…2005) and community and primary care group drop– in sessions (Rhodes & Nocon 2003). There is also further scope for strengthening relationships between primary and secondary care (Hawthorne 1990, David & Kendrick 2004).…”

“…Many recommendations can be applied to all patients regardless of ethnic minority status and include nurse-led educational delivery by managers ⁄ nurse clinicians (Peek et al 2007) or nurse specialists (New et al 2003), use of telephone support (Piette et al 1999) and community and primary care group drop-in sessions (Rhodes & Nocon 2003). There is also further scope for strengthening relationships between primary and secondary care (Hawthorne 1990, David & Kendrick 2004.…”

“…There is marked heterogeneity within South Asian groups showing the relative disadvantage of Pakistani and Bangladeshi groups, and significant interactions between disadvantage, ethnicity and health status, including glucose intolerance (Bhopal et al 2002). There is further evidence that patients who report ethnic discrimination in their lives have a higher incidence of poor health (David & Kendrick 2004) and a far lower probability of receiving clinical monitoring tests (Ryan et al 2008).…”

Immigrant women family caregivers in Canada: implications for policies and programmes in health and social sectors

“…The social and economic marginalisation of immigrants noted in the present Canadian study have been reported for other nations, notably the United Kingdom (Blakemore 2000). Recent reports reveal that health and social services for immigrants in the United Kingdom are less effective than those for non‐ethnic minorities, affecting access and use of available services (Blakemore 2000, Rhodes & Nocon 2003, David & Kendrick 2004, Quickfall 2004). In Canada, since the responsibility for immigrant settlement, health and social services is provincial, the disparities in services offered to immigrants vary.…”