Management of type 2 diabetes in general practice in Ireland: effect of the ‘Cycle of Care’ programme

Background Diabetes is a major cause of death and disability worldwide and is associated with vascular complications, which are reduced by control of risk factors. The introduction of the diabetes ‘cycle of care’ pay-for-performance programme in Ireland in January 2016 means that GPs have been resourced to provide structured care to patients with type 2 disease.

Aim To examine the effectiveness of the ‘cycle of care’ programme.

Method A computerised search was developed for diabetes data. Forty-one practices returned data for a 12-month period before (2014) and after (2017) the introduction of the ‘cycle of care’. International guidelines informed the analysis.

Results In total, 3189 patients were examined from 41 practices for the years 2014 and 2017. Nine practices were located in an urban setting (22%), 16 rural (39%), and 16 in a mixed location (39%); 1781 males (55.8%) and 1408 females (44.2%). In 2017, the mean age of participants was 68.5 years (standard deviation [SD] = 12.3) and 2277 (71.4%) patients had clinical data provided for both 2017 and 2014, 875 (27.4%) for 2017 only, 5 (0.2%) for 2014 only, and 32 (1.0%) for neither year. Substantial improvements in rates of recording and in levels of missing data were shown for HbA1c, lipids, renal function, blood pressure, and body mass index. Rates of foot review, retinopathy screening, treatment review, influenza immunisation, and patient education were recorded for the first time in 2017.

Conclusion The ‘cycle of care’ programme has resulted in substantial improvements in type 2 diabetes care in Ireland, supporting pay for performance.