Diabetes prevalence, process of care and outcomes in relation to practice size, caseload and deprivation: national cross-sectional study in primary care

Abstract

SUMMARYObjective To examine the association between practice list size, deprivation and the quality of care of patients with diabetes.Design Population-based cross-sectional study using Quality and Outcomes Framework data.Setting England and Scotland.Participants 55 522 778 patients and 8970 general practices with 1 852 762 people with diabetes.Interventions None.Main outcome measures Seventeen process and surrogate outcome measures of diabetes care.Results The prevalence of diabetes was 3.3%. Prevalence differed with practice list size and deprivation: smaller and more deprived practices had a higher mean prevalence than larger and more affluent practices (3.8% versus 2.8%). Practices with large patient list sizes had the highest quality of care scores, even after stratifying for deprivation. However, with the exception of retinal screening, peripheral pulses and neuropathy testing, differences in achievement between small and large practices were modest (55%). Small practices performed nearly as well as the largest practices in achievement of intermediate outcome targets for HbA1c, blood pressure and cholesterol (smallest versus largest practices: 57.4% versus 58.7%; 70.7% versus 70.7%; and 69.5% versus 72.7%, respectively). Deprivation had a negative effect on the achieved scores and this was more pronounced for smaller practices.Conclusion Our study provides some evidence of a volumeoutcome association in the management of diabetes in primary care; this appears most pronounced in deprived areas.

Economic incentives in general practice: The impact of pay-for-participation and pay-for-compliance programs on diabetes care

“…Most controls included at the practice level (medicine in network, medicine in group, rural practice location, proportion of diabetics) do not influence the observed outcome either. An interesting exception is list size where the negative coefficients confirms previous results [36], according to which larger practices provide better quality of diabetes care. As for the third level only aggregate per capita income significantly contributes to capture part of the residual heterogeneity.…”

Inequalities in health care among patients with type 2 diabetes by individual socio-economic status (SES) and regional deprivation: a systematic literature review

“…In all but two studies [21,35], the results were adjusted for age and sex. Also, many results were adjusted for diabetes duration [20-23,25,29,31,32,34,36,39] and BMI [21,23,33,37,39].…”

Prevalence and characteristics in coding, classification and diagnosis of diabetes in primary care

“…It is estimated that more than 80% of MODY cases in the UK are currently misdiagnosed as T1DM or T2DM 11. It is highly unlikely that the diagnosis of MODY can even be suspected in primary care where most people with diabetes are diagnosed and managed 12. Recently, the UK diagnostic testing centre reported a delay of about 13 years in the diagnosis of MODY and reported a wide variation of referral rates across the country 11.…”