title: Concordance facilitates access in diabetes care--service provider perspectives of service improvement and cultural competency.
abstract: OBJECTIVE
  Inequalities between different ethnic groups in diabetes care and outcomes are well documented in the UK. This research sought to explore and understand how national and local policy interventions impacted upon access and the development of culturally competent diabetes services from the care provider perspective.
  
  
  METHODS
  This paper describes the care provider perspective of access to diabetes care in ethnically mixed populations from a thematic analysis of 14 semi-structured interviews conducted with professionals, at three study sites, with different roles in the diabetes care pathway.
  
  
  RESULTS
  National policy level initiatives to improve quality have led to quality improvements at a practical level. These achievements, however, have been unable to address all aspects of care that service providers identified as important in facilitating access for all patient groups. Concordance emerged as a key process in improving access to care within local systems and barriers to this exist at different levels and are greater for some groups of patients compared with others.
  
  
  CONCLUSIONS
  Concordance is a key concept that underpins access and cultural competency in diabetes service improvement. A focus on concordance at different levels within local systems may improve access to quality diabetes care for ethnic minority groups.
authors.affiliation: Institute for Health Research, University of Bedfordshire, Luton, UK.
authors.forename: E
authors.initials: E
authors.lastname: Wilkinson
authors.forename: G
authors.initials: G
authors.lastname: Randhawa
mesh_terms: D001291:Attitude of Health Personnel; D054521:Cultural Competency; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000208:ethnology / Q000628:therapy; D005260:Female; D006297:Health Services Accessibility; D054625:Healthcare Disparities; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D036301:Qualitative Research; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D006113:United Kingdom / Q000453:epidemiology