Ethnic differences in Type 2 diabetes care and outcomes in Auckland: a multiethnic community in New Zealand.
BACKGROUND
In New Zealand, Maori and Pacific (mostly of Samoan, Tongan, Niuean, or Cook Islands origin) people with Type 2 diabetes are more likely to suffer poor outcomes than other New Zealanders. Responsibility for addressing this outcome differential is falling on primary care and general practice in particular. This paper compares the general practice care provided to people with Type 2 diabetes in South and West Auckland, according to ethnicity.


METHODS
An external audit of general practice diabetes care is carried out in South and West Auckland by the Diabetes Care Support Service. The results of 5917 routine patient audits carried out in 2003 are included in this study. Number of visits, recording of important information, risk factors, and treatments are compared between different ethnic groups.


RESULTS
Maori and Pacific people with diabetes who attend a regular GP had a higher average number of consultations than Europeans (5.7, 5.4, and 4.8 visits per year respectively). They were as likely as Europeans to have undergone important regular examinations and investigations. Maori were more likely than Europeans to be on some treatments. However, Maori and Pacific people were more likely to have a range of adverse risk factors for diabetes complications than Europeans. These include being a smoker (35, 18, and 13% respectively), having an HbA1c greater than 8% (50, 56, 23%), and having microalbuminuria (55, 50, 27%).


CONCLUSIONS
Although there were no large differences in the process measures of general practice diabetes care provided to different ethnic groups in South and West Auckland, Maori and Pacific people were not achieving the same outcomes of care in terms of risk factors for diabetes complications. Many of these risk factors are influenced by other factors in the wider community; however the New Zealand health system needs to consider how it can better address these differences.
Robinson
Tom
T
Counties-Manukau District Health Board, Auckland. trobinson@cmdhb.org.nz
Simmons
David
D
Scott
David
D
Howard
Eileen
E
Pickering
Karen
K
Cutfield
Rick
R
Baker
John
J
Patel
Ashwin
A
Wellingham
John
J
Morton
Sara
S
D000368:Aged; D006801:Humans; D008875:Middle Aged; D048909:Diabetes Complications / Q000208:ethnology; D003924:Diabetes Mellitus, Type 2 / Q000208:ethnology / Q000628:therapy; D005194:Family Practice; D008485:Medical Audit; D009520:New Zealand / Q000453:epidemiology; D010043:Outcome and Process Assessment, Health Care; D005791:Patient Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012307:Risk Factors; D044465:White People