Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years

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dc.contributor.author Riordan, Fiona
dc.contributor.author McHugh, Sheena M.
dc.contributor.author Harkins V.
dc.contributor.author Marsden P.
dc.contributor.author Kearney, Patricia M.
dc.date.accessioned 2018-05-24T14:51:40Z
dc.date.available 2018-05-24T14:51:40Z
dc.date.issued 2018-04-29
dc.identifier.citation Riordan F., McHugh S. M., Harkins V., Marsden P. and Kearney P. M. (2018) 'Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years', Diabetic Medicine, In Press. doi: 10.1111/dme.13658 en
dc.identifier.startpage 1 en
dc.identifier.endpage 9 en
dc.identifier.issn 0742-3071
dc.identifier.uri http://hdl.handle.net/10468/6190
dc.identifier.doi 10.1111/dme.13658
dc.description.abstract Aim: To examine the quality of care delivered by a structured primary care‐led programme for people with Type 2 diabetes mellitus in 1999–2016. Methods: The Midland Diabetes Structured Care Programme provides structured primary care‐led management. Trends over time in care processes were examined (using a chi‐squared trend test and age‐ and gender‐adjusted logistic regression). Screening and annual review attendance were reviewed. A composite of eight National Institute for Health and Care Excellence‐recommended processes was used as a quality indicator. Participants who were referred to diabetes nurse specialists were compared with those not referred (Student's t‐test, Pearson's chi‐squared test, Wilcoxon–Mann–Whitney test). Proportions achieving outcome targets [HbA1c ≤58 mmol/mol (7.5%), blood pressure ≤140/80 mmHg, cholesterol <5.0 mmol/l] were calculated. Results: Data were available for people with diabetes aged ≥18 years: 1998/1999 (n=336); 2003 (n=843); 2008 (n=988); and 2016 (n=1029). Recording of some processes improved significantly over time (HbA1c, cholesterol, blood pressure, creatinine), and in 2016 exceeded 97%. Foot assessment and annual review attendance declined. In 2016, only 29% of participants had all eight National Institute for Health and Care Excellence processes recorded. A higher proportion of people with diabetes who were referred to a diabetes nurse specialist had poor glycaemic control compared with those not referred. The proportions meeting blood pressure and lipid targets increased over time. Conclusions: Structured primary care led to improvements in the quality of care over time. Poorer recording of some processes, a decline in annual review attendance, and participants remaining at high risk suggest limits to what structured care alone can achieve. Engagement in continuous quality improvement to target other factors, including attendance and self‐management, may deliver further improvements. What's new? Most studies on the impact of multifaceted, structured, primary care programmes on the quality of diabetes care have a short follow‐up time; studies demonstrating long‐term sustainability are lacking. We found significant improvements in quality of care (care processes delivered) among practices enrolled in a primary care programme over a 16‐year period. Lifestyle processes were less well recorded, and there were declines in foot assessment and attendance at annual review, and participants continued to have poor risk factor control. Programmes may be limited when operating within the constraints of primary care and the wider service context. en
dc.description.sponsorship Health Research Board (Leaders Award in Diabetes (RL/2013/7)); Centre for Ageing Research and Development in Ireland (Fellowship from the Centre for Ageing Research andDevelopment in Ireland (CARDI), which became the AgeingResearch and Development Division within the Institute of Public Health in Ireland (IPH)) en
dc.format.mimetype application/pdf en
dc.language.iso en en
dc.publisher Wiley en
dc.relation.uri https://onlinelibrary.wiley.com/doi/abs/10.1111/dme.13658
dc.rights © 2018 Diabetes UK. This is the peer reviewed version of the following article: (2018) ‘Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years’, Diabetic Medicine, which has been published in final form at https://doi.org/10.1111/dme.13658. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Self-Archiving. en
dc.subject Diabetes mellitus en
dc.subject Structured primary care en
dc.subject The Midland Diabetes Structured Care Programme en
dc.subject Type 2 diabetes mellitus en
dc.subject Health service en
dc.subject Primary care en
dc.title Sustaining quality in the community: trends in the performance of a structured diabetes care programme in primary care over 16 years en
dc.type Article (peer-reviewed) en
dc.internal.authorcontactother Fiona Riordan, Public Health, University College Cork, Cork, Ireland. +353-21-490-3000 Email: fiona.riordan@ucc.ie en
dc.internal.availability Full text available en
dc.check.info Access to this article is restricted until 12 months after publication by request of the publisher en
dc.check.date 2019-04-29
dc.date.updated 2018-05-24T14:36:58Z
dc.description.version Accepted Version en
dc.internal.rssid 438880847
dc.contributor.funder Health Research Board en
dc.contributor.funder Centre for Ageing Research and Development in Ireland en
dc.description.status Peer reviewed en
dc.identifier.journaltitle Diabetic Medicine en
dc.internal.copyrightchecked No !!CORA!! en
dc.internal.licenseacceptance Yes en
dc.internal.IRISemailaddress fiona.riordan@ucc.ie en


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