title: How do people with diabetes describe their experiences in primary care? Evidence from 85,760 patients with self-reported diabetes from the English General Practice Patient Survey.
abstract: OBJECTIVE
  Developing primary care is an important current health policy goal in the U.S. and England. Information on patients' experience can help to improve the care of people with diabetes. We describe the experiences of people with diabetes in primary care and examine how these experiences vary with increasing comorbidity.
  
  
  METHODS
  Using data from 906,578 responders to the 2012 General Practice Patient Survey (England), including 85,760 with self-reported diabetes, we used logistic regressions controlling for age, sex, ethnicity, and socioeconomic status to analyze patient experience using seven items covering three domains of primary care: access, continuity, and communication.
  
  
  RESULTS
  People with diabetes were significantly more likely to report better experience on six out of seven primary care items than people without diabetes after adjusting for age, sex, ethnicity, and socioeconomic status (adjusted differences 0.88-3.20%; odds ratios [ORs] 1.07-1.18; P < 0.001). Those with diabetes and additional comorbid long-term conditions were more likely to report worse experiences, particularly for access to primary care appointments (patients with diabetes alone compared with patients without diabetes: OR 1.22 [95% CI 1.17-1.28] and patients with diabetes plus three or more conditions compared with patients without diabetes: OR 0.87 [95% CI 0.83-0.91]).
  
  
  CONCLUSIONS
  People with diabetes in England report primary care experiences that are at least as good as those without diabetes for most domains of care. However, improvements in primary care are needed for diabetes patients with comorbid long-term conditions, including better access to appointments and improved communication.
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, U.K. camp3@medschl.cam.ac.uk.
authors.forename: Charlotte A M
authors.initials: CA
authors.lastname: Paddison
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, U.K.
authors.forename: Catherine L
authors.initials: CL
authors.lastname: Saunders
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, U.K.
authors.forename: Gary A
authors.initials: GA
authors.lastname: Abel
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, U.K.
authors.forename: Rupert A
authors.initials: RA
authors.lastname: Payne
authors.affiliation: Wolfson Diabetes and Endocrine Clinic, Addenbrooke's Hospital, Institute of Metabolic Science, Cambridge, U.K.
authors.forename: Amanda I
authors.initials: AI
authors.lastname: Adler
authors.affiliation: Primary Care Unit, Institute of Public Health, University of Cambridge, Cambridge, U.K.
authors.forename: Jonathan P
authors.initials: JP
authors.lastname: Graffy
authors.affiliation: Cambridge Centre for Health Services Research, Institute of Public Health, University of Cambridge, Cambridge, U.K.
authors.forename: Martin O
authors.initials: MO
authors.lastname: Roland
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003142:Communication; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000523:psychology / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005194:Family Practice; D005260:Female; D058006:General Practice / Q000592:standards; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010817:Physician-Patient Relations; D011320:Primary Health Care / Q000592:standards; D057566:Self Report; D014481:United States / Q000453:epidemiology; D055815:Young Adult