ObjectiveTo examine the barriers to, and facilitators in, improving diabetes management from the general practice perspective, in advance of the implementation of an integrated model of care in Ireland.DesignQualitative using semistructured interviews.SettingPrimary care in the Republic of Ireland.ParticipantsPurposive sample of 29 general practitioners (GPs) and two practice nurses.MethodsData were analysed using a framework approach.ResultsThe main barriers and facilitators occurred at the level of the health system but had a ripple effect at an organisational, professional and patient level. The lack of targeted remuneration for diabetes management in the Irish health system created apathy in general practice and was perceived to be indicative of the lack of value placed on chronic disease management in the health system. There were ‘pockets of interest’ among GPs motivated by ‘vocational’ incentives such as a sense of professional duty; however, this was not sufficient to drive widespread improvement. The hospital service was seen as an essential support for primary care management, although some participants referred to emerging tension between settings. The lack of coordination at the primary–secondary interface resulted in avoidable duplication and an ‘in the meantime’ period of uncertainty around when patients would be called or recalled by specialist services. Facilitators included the availability of nursing support and serendipitous access to services. The lack of resources in the community was considered to be at odds with policy to shift routine management to general practice, which is fast reaching saturation.ConclusionsAt present, intrinsic motivation is driving the improvement of diabetes care in Ireland. This will not be sufficient to implement the proposed reform including a national model of integrated care. Policymakers need to assess and prepare for the disparate levels of interest and infrastructure in primary care in Ireland to support this change.

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Objective The patterns of relationships between diabetes and depression in countries of central and eastern Europe (CEE) might differ from those in countries of western Europe and USA. Among the reasons are specifics of transitioning health care systems (including mental health) and the general social, cultural and economic background of these countries. The aim of this paper is to fill in the existing information gap and analyse the prevalence of depression symptoms in patients with diabetes in Slovakia and to identify its predictors. Method 1043 diabetes patients from two diabetes outpatient-care offices were recruited for the study. The Patient Health Questionare 9 (PHQ-9) was applied to screen for depression symptoms. Patients were categorized into three categories based on depression symptom severity. Demographic and disease-related factors were analyzed as predictors of depression symptoms. Results In the univariate analysis a number of factors were associated with increasing severity of depression symptoms. In the multiavriate analysis lower education (OR 0.43;CI95% 0.28-0.65), and high degree of self-perceived severity of illness (OR 6.94;CI95% 3.39-14.97) were confirmed as independent predictors of depression symptoms in our patients. Conclusions Demographic and psychological factors have an important role in developing depression symptoms in patients with diabetes in our population. Further studies into the topic are needed to gain further clues on this topic throughout the Central European region. The findings of this study should be considered by mental health service providers and public health authorities to raise awareness about this important issue.