title: 'It sounds like a great idea but…': a qualitative study of GPs' attitudes towards the development of a national diabetes register.
abstract: OBJECTIVE
  The aim of this study was to investigate the attitudes of general practitioners (GPs) to the development of a national diabetes register as a way of improving the quality of care.
  
  
  METHODS
  Qualitative study using semistructured interviews.
  
  
  METHODS
  General practice, Ireland.
  
  
  METHODS
  Purposive sample of 29 GPs and two practice nurses. Participants' practices varied by (a) location (rural/urban), (b) size (single-handed/group practice) and (c) extent of computerisation.
  
  
  METHODS
  The semistructured topic guide focused on experiences of change in the health system at a local and national level and attitudes towards the development of a national diabetes register. Analysis was conducted using the Framework approach.
  
  
  RESULTS
  Participants were sceptical about the development of a national diabetes register. The main advantage was 'knowing the numbers' for epidemiological and policy purposes. However, participants questioned the benefits for their practice and patients. There were concerns that it would drain resources from other priorities and distract from patient management. These attitudes were strongly influenced by previous experience of change in the health system. Participants felt that remuneration would be necessary to ensure full engagement, reflecting wider frustrations with payment structures for general practice. There was a sense of wariness towards health service administration which was not specific to diabetes care but which coloured some participants' attitudes towards a national register. In contrast, participants referred to positive experiences of change at a local level, facilitated by a 'practice ethos' and professional leadership.
  
  
  CONCLUSIONS
  This study highlights the growing sense of scepticism and inertia towards change within the health system. This inertia stems from previous experience and the competing demands of maintaining versus improving care in a system with dwindling resources.
authors.affiliation: Department of Epidemiology & Public Health, University College Cork, Cork, Ireland.
authors.forename: Sheena M
authors.initials: SM
authors.lastname: Mc Hugh
authors.affiliation: Faculty of Health Care and Social Work, Department of Public Health, Trnava University, Trnava, Slovakia.
authors.forename: Monica
authors.initials: M
authors.lastname: O'Mullane
authors.affiliation: Department of Epidemiology & Public Health, University College Cork, Cork, Ireland.
authors.forename: Ivan J
authors.initials: IJ
authors.lastname: Perry
authors.affiliation: Department of General Practice, University College Cork, Cork, Ireland.
authors.forename: Colin
authors.initials: C
authors.lastname: Bradley
mesh_terms: D000328:Adult; D001291:Attitude of Health Personnel; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D058005:General Practitioners / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D007494:Ireland; D008297:Male; D036301:Qualitative Research; D058996:Quality Improvement; D012042:Registries
keywords: Diabetes Mellitus; General Practice; Qualitative Research; Quality Improvement