title: Management of diabetes in primary care: a structured-care approach.
abstract: BACKGROUND
  In the Irish Midland Health Service Executive (HSE) Diabetes Structured Care Project, additional resources were targeted at general practice in the absence of a local hospital-based specialized diabetes unit.
  
  
  OBJECTIVE
  We assessed the performance of the Midland HSE Diabetes Structured Care programme in 2003, bench-marked against Primary Care Trust (PCT) data from the 2003/2004 National Diabetes Audit for England.
  
  
  METHODS
  Data on 947 patients (72% of eligible patients) from all 20 general practices participating in the structured-care programme were collected retrospectively over a 12-month period. The data included demographic and clinical variables as well as key process-of-care and intermediate outcome indicators used in the National Diabetes Audit for England.
  
  
  RESULTS
  The level of recording of process-of-care measures was near or above the upper quartile for PCTs in England. The proportion of patients with HbA(1c) concentrations at target levels (<6.5%) in the Midlands HSE project (26.8%) was virtually identical to the upper quartile level for PCTs in England (27.4%). The proportion of patients reaching target total cholesterol levels (<5.0 mmol/l) (54.6%) was close to the mean for PCTs in England (56.6%), and performance with regard to target blood pressure levels was equally poor in both the Midlands HSE (18.0%) and in PCTs in England (20.8%).
  
  
  CONCLUSIONS
  Primary-care-led structured care, with relatively limited but well-focused investment, can achieve quality of care for patients with diabetes, comparable to international best practice.
authors.affiliation: Health Service Executive - Dublin/Mid-Leinster Area, Ireland.
authors.forename: Carmel
authors.initials: C
authors.lastname: Brennan
authors.forename: Velma
authors.initials: V
authors.lastname: Harkins
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D001794:Blood Pressure; D002784:Cholesterol / Q000097:blood; D003922:Diabetes Mellitus, Type 1 / Q000503:physiopathology / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D007494:Ireland; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011320:Primary Health Care / Q000379:methods* / Q000592:standards; D011787:Quality of Health Care; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D002784:Cholesterol; D006442:Glycated Hemoglobin