Inequalities in provision of systematic care for patients with diabetes

Background. GPs are now playing a greater role in the care of people with d iabetes; however, the level of performance in primary care is variable. Pra ctices with a recall system and diabetes mini-clinic have been shown to ach ieve better outcome of care of patients with diabetes. Systematic care also requires effective community-based diabetes services and access to primary care diabetes teams including dieticians, chiropodists, and optometrists a nd ophthalmologists. Objectives. The aims of this study were to determine how services for peopl e with diabetes are organized in primary care and whether there are inequal ities in systematic care of people with diabetes. Methods. A piloted postal questionnaire was sent to all 327 general practic es in three health authorities in England serving a population of >2 millio n people. The three health authorities provided practice-based routine data relating to all general practices. Results. A total of 264 (80.7%) practices replied; 236 (89.4%) employed a d iabetes recall system and 196 (74.2%) reviewed their patients in a diabetes mini-clinic. Multiple regression showed that having a recall system was as sociated independently with a GP [odds ratio (OR) 6.2; 95% confidence inter val (CI) 2.6-14.9] or a practice nurse (OR 3.5; 1.4-8.7) with an interest i n diabetes. Having a diabetes mini-clinic was associated independently with a GP with an interest in diabetes (OR 4.1;2.1-7.8), a practice nurse havin g attended a diabetes course (OR 2.8, 1.3-6.2), practices with more partner s (OR 1.2 per additional partner; 1.0-1.4) and fundholding practices (OR 2. 6; 1.2-5.5). One hundred and sixteen (43.9%) practices had a chiropodist pr esent in the practice, and 90 (34.1%) had a practice-based dietician. A chi ropodist and a dietician were significantly more likely to be attached in t raining practices and in less deprived areas. A practice-based dietician wa s significantly associated with larger practices. Conclusions. Providing high quality primary care is essential to meeting th e government's agenda of reducing inequalities. This study shows high level s of structured diabetes care which are not related to deprivation. However , practices in more deprived areas still lag behind practices in more afflu ent areas in terms of access to members of the diabetes team. To improve ca re of people with diabetes in primary care, deficiencies and inequalities h ighlighted in our survey must be addressed. The results of this survey will be valuable to primary care groups and organizations responsible for commi ssioning diabetes services.