Standards of care of diabetic patients in a typical English community.

Abstract

BACKGROUND: Poole has a well-established system of sharing care of patients with diabetes between hospital and general practitioners. Very few comprehensive audits of the effectiveness of such a system, which is being adopted in many areas of the UK, have been carried out. AIM: A study was set up to survey structure, process and outcome of care for as many diabetic patients in the Poole area as possible, and to feed the results back to individual practices. METHOD: Structure criteria were assessed by self-completion questionnaire. Process and outcome criteria were assessed by visits to practices and examination of individual patient notes. A total of 37 practices were visited and the notes of 3974 patients reviewed. Results were analysed by practice and for the district as a whole, and were sent to each practice for comparison. RESULTS: The overall prevalence of diabetes in the area was 1.61%, with a marked preponderance of elderly patients (14.1% were over 80). The overall male to female ratio was 1.2:1. The structure questionnaire pinpointed deficiencies in audit facilities, completeness of diabetic registers, and in general use of optometrists and chiropodists. Process criteria analysis showed that, within the last 13 months, 44% of patients under sole care of a general practitioner had undergone full eye examination, cholesterol levels had been checked in 25%, smoking status in 50%, and some foot inspection had been carried out in 57%. Glycaemic control and blood pressure had been measured in over 75% of patients. Outcome analysis showed, in those patients in which they were measured, mean glycosylated haemoglobin (Hba1c) to be 8.07% (upper limit of normal, ULN = 6.5%), some degree of retinopathy to be present in 17.3%, hypertension in 27%, and hypercholesterolaemia in 33%. CONCLUSION: Standards of care of diabetics by general practitioners in the Poole area are not optimal, although they are as good as those reported for other districts. Glycaemic control was generally poor, especially in those patients needing insulin to control the disease. Vascular disease risk factors need to be targeted, and eye examination systems and chiropody services improved.