Diabetes mellitus in Irish general practice: level of care as reflected by HbA1c values.
OBJECTIVE
To assess the level of care given to people with diabetes by general practitioners and factors affecting it.


METHODS
A cross-sectional study of Irish general practitioners, looking at practice characteristics and patient care over the previous 2 years; a nationally representative sample of 27 general practitioners. A total of 1030 people with diabetes were studied, of whom 201 were type 1 and 829 were type 2.


RESULTS
The response rate was 27 out of 52 (52%). HbA1c values were not related to the patient's socioeconomic status. The average HbA1c for type 1 people with diabetes was 7.81%, and for type 2 it was 7.1%. HbA1c values were measured 3.02 times for type 1 and 3.16 times for people with type 2 diabetes. This is a good standard of care, especially for type 2 disease. Computerized practices and those patients whose care was shared with the hospital achieved better control, even though HbA1c levels were checked less frequently with computerization. The use of a protocol in the practices also improved care. Those practices employing a nurse had increased frequency of measurement of HbA1c and better control on univariate but not on multivariate analysis. Possible reasons for this are discussed.


CONCLUSIONS
Diabetes Mellitus is treated to a good standard in Irish general practice, especially type 2 disease. This standard appears to be independent of the patient's socio-economic status, is improved by GPs being computerised, in group practices and by providing care according to a protocol. Shared care also improves control. Employing a practice nurse may also improve care.
O'Connor
Ray
R
Mid-Western Specialist Training Programme in General Practice, University of Limerick, Limerick, Ireland. rocthedoc@eircom.net
Houghton
Frank
F
Saunders
Jean
J
Dobbs
Frank
F
D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000097:blood* / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000628:therapy; D005194:Family Practice; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006123:Group Practice; D019983:Guideline Adherence; D006801:Humans; D007494:Ireland; D008297:Male; D016347:Medical Records Systems, Computerized; D008875:Middle Aged; D009722:Nurse Practitioners; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012044:Regression Analysis; D011795:Surveys and Questionnaires; D016896:Treatment Outcome
D006442:Glycated Hemoglobin