Diabetes care in Ireland: A survey of general practitioners

Abstract

Aim To investigate the organisation of diabetes care in general practice in Ireland and identify areas for future development. Methods Survey of a representative sample of 600 general practitioners (GPs). The questionnaire contained closed and open-ended questions addressing 4 topics; characteristics of the practice, diabetes care delivery, use of services and opportunities for developing diabetes care. Results The response rate was 44% ( n = 262). There were an additional 86 responses to a follow-up shortened version of the survey resulting in a 58% response rate for 9 key questions. The majority of respondents were from an urban (43%, n = 112) or a mixed area (39%, n = 101) and 19% of practices were single-handed ( n = 66). The reported prevalence in participating practices was 0.7% for Type 1 diabetes and 2.8% for Type 2 diabetes. Forty-five percent of GPs maintained a diabetes register ( n = 157) while 53% reported using guidelines ( n = 140). A formal call recall system was reported by 30% ( n = 78) with a further 20% ( n = 54) reporting a regular if informal approach to calling patients for review. With regard to the use of diabetes related services 63% reported direct access to a dietician ( n = 165), 57% direct access to chiropody services ( n = 149) and 89% had direct access to retinopathy screening ( n = 234). There was a significant association between maintaining a diabetes register and other aspects of care delivery such as engaging in formal recall ( p < 0.001), using guidelines ( p < 0.001) and a declared special interest in diabetes ( p = 0.001). Of a number of choices 75% of GPs thought that training was the principal opportunity for improving diabetes care. In response to the open-ended questions GPs cited lack of resources, time constraints and workload as barriers to effective care delivery. Conclusions Delivery of diabetes care in Ireland remains largely unstructured. Key challenges to improving diabetes care appear to extend to the system and organisational level of care delivery.