The effect of ‘paying for performance’ on the management of type 2 diabetes mellitus: a cross-sectional observational study

O'Connor, Raymond G.; O'Driscoll, Rory; O’Doherty, Jane; Hannigan, Ailish; O’Neill, Aoife; Teljeur, Conor; O’Regan, Andrew

doi:10.3399/bjgpopen20x101021

Cited by 7 publications

(7 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It has been available for the care of people with Type 2 Diabetes who are registered with PCRS since 2017. It has benefited these patients by improving and standardising the recording of clinical information and has also shown an improvement in the achievement of clinical targets [ 43 ].…”

Section: Discussionmentioning

confidence: 99%

Blood pressure control in patients with a previous stroke/transient ischaemic attack in primary care in Ireland: a cross sectional study

et al. 2020

View full text Add to dashboard Cite

Background Uncontrolled blood pressure (BP) is an important modifiable risk factor for recurrent stroke. Secondary prevention measures when implemented can reduce stroke re-occurrence by 80%. However, hypertension control rates remain sub-optimal, and little data is available from primary care where most management occurs. The aim of this study was to describe BP control in primary care-based patients with a previous stroke or transient ischaemic attack (TIA) in Ireland, and to concurrently examine antihypertensive medication-dosing. Methods Study participants most recent office-based BP reading was compared with the NICE (NG136) and European Society of Hypertension/ European Society of Cardiology (ESH/ESC 2013) goal of BP < 140/90 mmHg. Optimal anti-hypertensive medication dosing was determined by benchmarking prescribed doses for each drug with the World Health Organisation-Defined Daily Dosing (WHO-DDD) recommendations. Results We identified 328 patients with a previous stroke or TIA in 10 practices. Blood pressure was controlled in almost two thirds of patients when measured against the ESH/ESC and NICE guidelines (63.1%, n = 207). Of those with BP ≥140/90 ( n = 116), just under half ( n = 44, 47.3%) were adequately dosed in all anti-hypertensive medications when compared with the WHO-DDD recommendations. Conclusion Blood pressure control in patients post stroke/TIA appears sub-optimal in over one third of patients. A comparison of drug doses with WHO-DDD recommendations suggests that 47% of patients may benefit from drug-dose improvements. Further work is required to assess how best to manage blood pressure in patients with a previous stroke or TIA in Primary Care, as most consultations for hypertension take place in this setting.

show abstract

Section: Discussionmentioning

confidence: 99%

Blood pressure control in patients with a previous stroke/transient ischaemic attack in primary care in Ireland: a cross sectional study

et al. 2020

View full text Add to dashboard Cite

show abstract

“…This policy incentivises GPs to provide structured annual reviews and improved records for people with type 2 diabetes. While this may have improved patient care in ROI [58] any decline in the availability of GPs per capita in the future due to increased demand [59], or supply factors such as training emigration or retirements [22] may counteract any positive benefits in the long run. In addition, the Cycle of Care scheme does not provide funding for patients without public medical cover, which comprise 32% of people over 50 years of age with diabetes [31].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2020

View full text Add to dashboard Cite

Background There are social and economic differences between Northern Ireland (NI) and the Republic of Ireland (ROI). There are also differences in the health care systems in the two jurisdictions. The aims of this study are to compare health (prevalence of diabetes and related complications) and health care utilisation (general practitioner, outpatient or accident and emergency utilisation) among older people with diabetes in the NI and ROI. Methods Large scale comparable surveys of people over 50 years of age in Northern Ireland (NICOLA, wave 1) and the Republic of Ireland (TILDA, wave 1) are used to compare people with diabetes (type I and type II) in the two jurisdictions. The combined data set comprises 1536 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 (age, gender, education, smoking status and self-related health, number of other chronic diseases and number of diabetic complications). Results The overall prevalence of diabetes 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 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 Despite the proximity of NI and ROI there are substantial differences in the prevalence of diabetes and its related complications. Despite differences in the health services in the two jurisdictions the differences in health care utilisation for an equivalent cohort are small.

show abstract

“…This, combined with target‐driven management of glucose, blood pressure and lipid levels, can reduce the incidence and impact of diabetic complications. Recent changes in the reimbursement of general practitioners (GPs) in Ireland for chronic disease management 10 and structured care for diabetes 11 aim to reduce the incidence and progression of diabetic complications through better management of the disease.…”

Section: Introductionmentioning

confidence: 99%

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

et al. 2021

View full text Add to dashboard Cite

Aims Type 2 diabetes is a major public health issue that has a large effect on society including its health and social services. The aims of this paper are to generate a projection of the number of cases and explore the potential impact of a preventive intervention targeted at people with pre‐diabetes on disease prevalence, complications, mortality and cost. Methods A Markov simulation model of diabetes and pre‐diabetes in Ireland, for the period 1991 to 2036, was generated based on international epidemiological data. The simulation was calibrated with the available Irish data on the prevalence of pre‐diabetes, diabetes and diabetic complications. The economic and health impact of a hypothetical nationwide preventive intervention programme, which reduces the incidence by a factor consistent with the international literature, was estimated under three scenarios of alternative effectiveness and uptake. Results The estimated number of people over 40 years of age with type 2 diabetes in Ireland is projected to increase from 216,000 in 2020 to 414,000 in 2036. A prevention programme, based on the NHS Diabetes Prevention Programme, is estimated to result in a reduction of between 2000 (0.5%) and 19,000 (4.6%) in the number of prevalent cases of diabetes in 2036 resulting in substantial health and quality of life benefits. Conclusions A wide range of initiatives with uncertain outcomes will be required to reduce the impact of obesity and type 2 diabetes. A diabetes prevention programme seems likely to be worth pursuing as one element of this set of initiatives.

show abstract

The effect of ‘paying for performance’ on the management of type 2 diabetes mellitus: a cross-sectional observational study

Cited by 7 publications

References 19 publications

Blood pressure control in patients with a previous stroke/transient ischaemic attack in primary care in Ireland: a cross sectional study

Blood pressure control in patients with a previous stroke/transient ischaemic attack in primary care in Ireland: a cross sectional study

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

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

Contact Info

Product

Resources

About