Quality of diabetes care in patients with schizophrenia and bipolar disorder: cross-sectional study.
OBJECTIVE
To determine whether patients with severe mental illness receive poorer health care for diabetes than patients without.


METHODS
This population-based cross-sectional survey used electronic general practice records from 481 UK general practices contributing to the QRESEARCH database. The records of 11 043 patients with diabetes, drawn from a database population of over 9 million patients, were extracted. Unadjusted and adjusted odds ratios were calculated using unconditional logistic regression for each of 17 quality indicators for diabetes care from the new General Medical Services contract for general practitioners.


RESULTS
The presence of severe mental illness did not reduce the quality of care received; the only significant difference between groups showed that such patients were more likely to have glycated haemoglobin < 7.5%[adjusted odds ratio = 1.45 (99% confidence interval 1.20-1.76)]. Increasing age was associated with better care [adjusted odds ratios from 1.06 (1.02-1.11) to 1.61 (1.52-1.70)], but other confounding variables had no consistent effect across indicators. Overall, performance against government targets was good.


CONCLUSIONS
The hypothesis of poorer diabetes care for those with severe mental illness is disproved, perhaps surprisingly, in the light of other recent UK studies showing inequalities in care for the mentally ill. The study does not reveal who is providing this good care (general practitioners, psychiatrists or diabetologists) or take account of the estimated 600 000 people in the UK with undiagnosed diabetes.
Three Bridges, West London Mental Health NHS Trust, London, UK. sean.whyte@nhs.net
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S
Whyte
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Penny
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Phelan
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Hippisley-Cox
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Majeed
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001714:Bipolar Disorder / Q000150:complications / Q000628:therapy*; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care; D012559:Schizophrenia / Q000150:complications / Q000628:therapy*; D006113:United Kingdom