Do Asians with diabetes in Sandwell receive inferior primary care? A retrospective cohort study.
Although diabetes is more prevalent among Asian people, Asians with diabetes are anecdotally believed to receive a lesser standard of care, compared with non-Asians. The aim of this study was to evaluate whether Asian patients with diabetes in Sandwell receive an inferior standard of care in primary care compared with non-Asians. Standards were based on tests carried out, in compliance with Sandwell's Diabetes Local Clinical Guideline. Data were collected from records of 774 patients with diabetes in 14 Sandwell practices. Proportions were recorded of Asian patients receiving specified tests, compared with non-Asians. No significant differences were observed between Asians and non-Asians for checks on feet, eyes, body mass index (BMI), smoking or blood pressure. Significantly fewer Asians received an HbA1c check. The mean HbA1c value was higher in Asians. More Asian patients received a urine test than non-Asians. Asian patients generally had lower BMI values. When stratified by practice however, no significant differences between Asians and non-Asians were observed for any single check. No significant differences were found between the overall proportions of checks carried out between Asians and non-Asians. A wide variation was observed in the proportion of patients who had individual checks done, between practices. There were no systematic differences in the standard of care given to Asian and non-Asian patients. Practices varied a great deal in the extent to which they carry out, and record, checks on patients with diabetes. A possible explanation for the reason that no summary result showed a significant difference was due to the confounding effect of the practice: that general practices tended to treat all their patients--Asian and non-Asian--similarly. Nevertheless, general practitioners should therefore take steps to ensure that all patients with diabetes have these checks at recommended intervals.
Stewart
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Department of Public Health, Sandwell Health Authority, Kingston House, 438 High Street, West Bromwich, West Midlands B70 9LD, England. antony.stewart@btinternet.com
Rao
J N
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D001208:Asia / Q000208:ethnology; D003920:Diabetes Mellitus / Q000628:therapy*; D004739:England; D005194:Family Practice / Q000592:standards*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D008485:Medical Audit; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012306:Risk; D018709:Statistics, Nonparametric