Differences in the structure of outpatient diabetes care between endocrinologist- led and general physician- led services

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dc.contributor.author O'Donnell, Máire
dc.contributor.author de Siún, Anna
dc.contributor.author O'Mullane, Monica
dc.contributor.author Smith, Diarmuid
dc.contributor.author Bradley, Colin P.
dc.contributor.author Finucane, Francis M.
dc.contributor.author Dinneen, Sean F.
dc.date.accessioned 2016-02-08T13:08:27Z
dc.date.available 2016-02-08T13:08:27Z
dc.date.issued 2013-11-25
dc.identifier.citation O’DONNELL, M., DE SIÚN, A., O’MULLANE, M., SMITH, D., BRADLEY, C., FINUCANE, F. M. & DINNEEN, S. F. 2013. Differences in the structure of outpatient diabetes care between endocrinologist- led and general physician- led services. BMC Health Services Research, 13:493, 1-5. http://dx.doi.org/10.1186/1472-6963-13-493 en
dc.identifier.volume 13 en
dc.identifier.startpage 1 en
dc.identifier.endpage 5 en
dc.identifier.issn 1472-6963
dc.identifier.uri http://hdl.handle.net/10468/2260
dc.identifier.doi 10.1186/1472-6963-13-493
dc.description.abstract Background: Despite a shift in diabetes care internationally from secondary to primary care, diabetes care in the Republic of Ireland remains very hospital-based. Significant variation in the facilities and resources available to hospitals providing outpatient diabetes care have been reported in the UK. The aim of this study was to ascertain the structure of outpatient diabetes care in public hospitals in the Republic of Ireland and whether differences existed in services provided across hospitals. Methods: We conducted a cross sectional observational study of the 36 public general hospitals providing adult outpatient diabetes care in the Republic of Ireland. Data relating to numbers of specialist medical, nursing and allied health professionals, waiting times for new and return patients, patterns of discharge back to primary care and engagement in quality improvement initiatives were recorded. Results: Thirty-five of the 36 eligible hospitals participated in the study. Sixty percent of these had at least one consultant endocrinologist in post, otherwise care delivery was led by a general physician. Waiting times for newly diagnosed patients exceeded six months in 30% of hospitals and this was higher where an endocrinologist was in place (47% V 7%, p = 0.013). Endocrinologists were more likely to have developed subspecialty clinics, access to allied health professionals and engage more in quality improvement initiatives but less likely to discharge patients back to primary care than general physicians (76 v 29%, p = 0.005). Conclusions: Variations exist in the structure and provision of diabetes care in Irish hospitals. Endocrinology-led services have more developed subspecialty structures and access to specialist allied health professionals and engage more in quality improvement initiatives. Nonetheless, waiting times are longer and discharge rates to primary care are lower than for non-specialty led services. Further studies to determine the extent to which case-mix variation accounts for these observations are warranted. Aspects of hospital-based outpatient care could be developed further to ensure equitable services are provided nationally. At a time when the delivery of diabetes services in primary care is being promoted, further research is warranted on the factors influencing the successful transition to primary care. en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher BioMed Central Ltd. en
dc.rights © O’Donnell et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. en
dc.rights.uri http://​creativecommons.​org/​licenses/​by/​2.​0 en
dc.subject Structured diabetes care en
dc.subject Hospital outpatients en
dc.subject Endocrinologist en
dc.subject General physician en
dc.title Differences in the structure of outpatient diabetes care between endocrinologist- led and general physician- led services en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Colin Bradley, Department of General Practice, University College Cork, Cork, Ireland. +353-21-490-3000 Email: C.Bradley@ucc.ie en
dc.internal.availability Full text available en
dc.description.version Published Version en
dc.contributor.funder Health Research Board en
dc.description.status Peer reviewed en
dc.internal.IRISemailaddress c.bradley@ucc.ie en
dc.identifier.articleid 493


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© O’Donnell et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Except where otherwise noted, this item's license is described as © O’Donnell et al.; licensee BioMed Central Ltd. 2013. This article is published under license to BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://​creativecommons.​org/​licenses/​by/​2.​0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
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