Are there disparities in care in people with diabetes? A review of care provided in general practice

Abstract

AIM: To estimate the prevalence of diabetes by age, gender and ethnicity; to look at quality of care and to investigate disparities in care. METHOD: A cross-sectional study in three practices in Hamilton. A comprehensive register was generated by identifying patients with diabetes through queries on the practices’ computer system looking for diagnosis codes for diabetes, prescription of hypoglycaemic agents, participation in the ‘Get Checked’ programme or laboratory test for HbA1c. We then compared the glycaemic control and uptake of retinal screening in adult patients with Type 2 diabetes. RESULTS: The overall prevalence of diabetes in patients aged 20 years or older was 1221/26 096 (4.7%). Eighty percent had attended for a ‘Get Checked’ annual review in the last 12 months. After adjusting for age, we found that Maori, males and those diagnosed more than five years ago were at increased risk of having unsatisfactory glycaemic control. Maori or Asian patients and women appeared less likely to have accessed retinal screening in the last two years. DISCUSSION: Computerised records including diagnostic codes and prescriptions in general practices can be used to develop comprehensive diabetes registers. Whilst this study shows that high levels of annual review can be achieved in patients with diabetes, the next challenge is to tackle the disparities in uptake of services such as retinal screening or the achievement of intermediate outcomes such as good glycaemic control. KEYWORDS: Diabetes mellitus; prevalence; health care disparities; ethnic groups; primary health care