title: Sharing specialist skills for diabetes in an inner city: a comparison of two primary care organisations over 4 years.
abstract: OBJECTIVE
  To evaluate the effects of organizational change and sharing of specialist skills and information technology for diabetes in two primary care groups (PCGs) over 4 years.
  
  
  METHODS
  In PCG-A, an intervention comprised dedicated specialist sessions in primary care, clinical guidelines, educational meetings for professionals and a shared diabetes electronic patient record (EPR). Comparison was made with the neighbouring PCG-B as control. In intervention and control PCGs, practice development work was undertaken for a new contract for family doctors. Data were collected for clinical measures, practice organizational characteristics and professional and patient views.
  
  
  RESULTS
  Data were analysed for 26 general practices including 17 in PCG-A and nine in PCG-B. The median practice-specific proportions of patients with HbA1c recorded annually increased in both areas: PCG-A from median 65% to 77%, while PCG-B from 53% to 84%. For cholesterol recording, PCG-A increased from 50% to 76%, and PCG-B from 56% to 80%. Organizational changes in both PCGs included the establishment of recall systems, dedicated clinics and educational sessions for patients. In both PCGs, practices performing poorly at baseline showed the greatest improvements in organization and clinical practice. Primary care professionals' satisfaction with access and communication with diabetes specialist doctors and nurses increased, more so in the intervention PCG. Only 16% of primary care professional respondents used the diabetes EPR at least monthly. Patient satisfaction and knowledge did not change.
  
  
  CONCLUSIONS
  Improvements in practices' organizational arrangements were associated with improvements in clinical care in both PCGs. Sharing specialist skills in one PCG was associated with increased professional satisfaction but no net improvement in clinical measures. A shared diabetes EPR is unlikely to be used, unless integrated with practice information systems.
authors.affiliation: Division of Health and Social Care Research, King's College London, London, UK.
authors.forename: Abdu
authors.initials: A
authors.lastname: Mohiddin
authors.forename: Smriti
authors.initials: S
authors.lastname: Naithani
authors.forename: Dan
authors.initials: D
authors.lastname: Robotham
authors.forename: Olubukola
authors.initials: O
authors.lastname: Ajakaiye
authors.forename: Dominic
authors.initials: D
authors.lastname: Costa
authors.forename: Steve
authors.initials: S
authors.lastname: Carey
authors.forename: Richard H
authors.initials: RH
authors.lastname: Jones
authors.forename: Martin C
authors.initials: MC
authors.lastname: Gulliford
mesh_terms: D003920:Diabetes Mellitus / Q000628:therapy*; D004739:England; D006123:Group Practice / Q000458:organization & administration*; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008137:Longitudinal Studies; D008498:Medical Record Linkage; D016347:Medical Records Systems, Computerized; D008511:Medicine; D017060:Patient Satisfaction; D013038:Specialization; D011795:Surveys and Questionnaires; D014505:Urban Population