Differences in the process of diabetic care between south Asian and white patients in inner-city practices in Nottingham, UK.
The prevalence and complication rate of diabetes is higher amongst British south Asians when compared to the rest of the adult population. There is some evidence to suggest that there are differences in access to healthcare in the UK for different ethnic groups, but there has been little research examining differences in processes of care between ethnic groups and place of delivery of diabetic care. The present study was a retrospective, multi-practice audit exploring differences in the processes of diabetic care provided to white and south Asian patients. Data were obtained from eight practices located in deprived areas in Nottingham, UK. A review of the evidence-based protocols for the monitoring of diabetic care generated a list of process criteria to be measured. All primary care data sources were examined over a 12-month period by a single investigator. The data were analysed with respect to patient ethnicity and place of diabetic care after adjusting for confounders. Eight hundred and thirty-nine diabetic patients were included in the audit and 671 (80.0%) received a formal annual diabetic review. One hundred and five (12.5%) patients were classified as south Asian. They were significantly less likely to have their blood pressure [86% versus 89%, odds ratio (OR) = 0.62, 95% confidence interval (95% CI) = 0.54-0.72] or serum creatinine (67% versus 76%, OR = 0.41, 95% CI = 0.32-0.52) measured when compared to white patients. Patients receiving shared care from a hospital-based diabetic team were more likely to have a range of items of the annual review recorded. When examined by ethnicity, south Asians receiving shared care were again less likely than white patients to have their blood pressure and serum creatinine measured. There was also some evidence that they may be less likely to have their body mass index recorded and their feet examined. The findings of the present study showed that, although most diabetic patients received a formal annual clinical review, scope for improvement remained. Shared care of patients with a hospital-based team produced better results when processes of care were examined. However, this benefit did not apply equally to south Asian and white patients. Further studies are indicated to confirm these results, which may have wider implications for the planning and provision of diabetic care.
Division of Primary Care, School of Community Health Sciences, University of Nottingham, Nottingham NG7 2RD, UK. christopher.david@nottingham.ac.uk
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Christopher
Denise
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Kendrick
D001208:Asia / Q000208:ethnology; D044466:Asian People / Q000706:statistics & numerical data*; D016001:Confidence Intervals; D003920:Diabetes Mellitus / Q000208:ethnology / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D005791:Patient Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D013223:Statistics as Topic; D006113:United Kingdom / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data