title: Quality improvements in diabetes care, how holistic have they been? A case-study from the United Kingdom.
abstract: OBJECTIVE
  As quality in diabetes care includes patient centred support for self-management, investigating patients' experiences upon diagnosis can help improve access to this element of care among diverse populations. This research explored this care in the context of recent national quality improvement initiatives which support self-management.
  
  
  METHODS
  South Asian and White European patients over 16 years with a recent (< 1 year) diagnosis of diabetes were recruited from 18 General Practitioner (GP) practices in three UK locations--Luton, West London and Leicester. A semi-structured qualitative interview was conducted with 47 patients.
  
  
  RESULTS
  Twenty one out of 47 (45%) reported unmet support and information needs at diagnosis. Although there was a small proportion of participants (8 out of 47, 17% of all respondents) who felt they did not require any help or support with managing their diabetes because their GP had provided comprehensive and efficient care, there was an equal number who voiced a negative view of the care they had received to date. This concerned information giving, support and communication, suggesting that recently implemented national quality improvement interventions may not have been successful in improving all aspects of diabetes care, particularly those encouraging self-management. The emerging analysis led to consideration of concordance as an important concept through which to understand inequalities and improve access to quality diabetes care. In order to encourage self-management from the start, care providers need to be cognisant that patients are not homogeneous and be responsive to their different information needs and emotional responses to diagnosis.
  
  
  CONCLUSIONS
  In order to support self-management and deliver patient centred care in diverse populations, care providers will need to be adaptable to individual needs around diagnosis.
authors.forename: Emma
authors.initials: E
authors.lastname: Wilkinson
authors.affiliation: Institute for Health Research, University of Bedfordshire, Hitchin Road, Luton LU2 8LE, UK. gurch.randhawa@beds.ac.uk.
authors.forename: Gurch
authors.initials: G
authors.lastname: Randhawa
authors.forename: Maninder
authors.initials: M
authors.lastname: Singh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D058006:General Practice / Q000592:standards*; D006301:Health Services Needs and Demand; D006694:Holistic Health; D006801:Humans; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D018802:Patient-Centered Care / Q000592:standards*; D036301:Qualitative Research; D058996:Quality Improvement; D012648:Self Care; D011795:Surveys and Questionnaires; D006113:United Kingdom
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