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Ethnicity and Quality of Diabetes Care in a Health System with Universal Coverage: Population-Based Cross-sectional Survey in Primary Care

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Abstract

BACKGROUND

The UK has a universal health care system that is free at the point of access. Over the past decade, the UK government has implemented an ambitious agenda of quality improvement initiatives in chronic disease management.

OBJECTIVE

To assess the quality of diabetes care and intermediate clinical outcomes within a multiethnic population after a sustained period of investment in quality improvement.

DESIGN

Population based cross-sectional survey, using electronic general practice records, carried out between November 2005 and January 2006.

PATIENTS

Seven thousand six hundred five adults (≥18 years) with diabetes registered with 32 primary care practices.

MEASUREMENTS

Percentage achievement by ethnic group (black, south Asian, or white) of the quality indicators for diabetes in a new pay-for performance contract.

RESULTS

There were only modest variations in recording of process measures of care between ethnic groups, with no significant differences in recent measurement of blood pressure, HbA1c, cholesterol, micro-albuminuria, creatinine, or retinopathy screening attendance. Blacks and south Asians were significantly less likely to meet all three national treatment targets for diabetes (HbA1c ≤ 7.4%, blood pressure ≤ 145/85 mmHg, total cholesterol ≤ 5 mmol/L [193 mg/dL]) than whites (25.3%, 24.8% , and 32.0%, respectively).

CONCLUSIONS

Our findings suggest that substantial investment in quality improvement initiatives in the UK may have led to more systematic and equitable processes of care for diabetes but have not addressed ethnic disparities in intermediate clinical outcomes.

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Acknowledgements

We thank the primary care practices that participated in the study. Ethical approval was granted by Wandsworth Local Research Ethics Committee.

Funding/support:

The Wandsworth Primary Care Research Centre and the Wandsworth Prospective Diabetes Study are funded by the Department of Health. The Wandsworth Prospective Diabetes Study has also received support from the MRC through the Virtual Organisation of Trials and Epidemiological Studies project. SS holds a National Postdoctoral Award from the UK Department of Health Research Capacity Development Program. Imperial College receives a contribution toward AM’s salary from the English Diabetes Research Network. The sponsor was not involved in the design and conduct of the study; collection, management, analysis, and interpretation of the data; and preparation, review, or approval of the manuscript.

Conflict of interest

None disclosed.

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Authors and Affiliations

  1. Wandsworth Primary Care Research Centre, Wandsworth Primary Care Trust, London, SW11 6HN, UK

    Jeremy Gray MRCP MRCGP & Christopher Millett MSc MFPH

  2. Department of Primary Care & Social Medicine, Imperial College Faculty of Medicine, London, W6 8RP, UK

    Christopher Millett MSc MFPH, Sonia Saxena MD MRCGP, Gopalakrishnan Netuveli BDS PhD & Azeem Majeed MD FRCGP

  3. Department of Health Sciences, University of Leicester, Leicester General Hospital, Leicester, LE5 4PW, UK

    Kamlesh Khunti MD FRCGP

Authors
  1. Jeremy Gray MRCP MRCGP
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  2. Christopher Millett MSc MFPH
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  3. Sonia Saxena MD MRCGP
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  4. Gopalakrishnan Netuveli BDS PhD
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  5. Kamlesh Khunti MD FRCGP
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  6. Azeem Majeed MD FRCGP
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Corresponding author

Correspondence to Christopher Millett MSc MFPH.

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Gray, J., Millett, C., Saxena, S. et al. Ethnicity and Quality of Diabetes Care in a Health System with Universal Coverage: Population-Based Cross-sectional Survey in Primary Care. J GEN INTERN MED 22, 1317–1320 (2007). https://doi.org/10.1007/s11606-007-0267-4

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  • DOI: https://doi.org/10.1007/s11606-007-0267-4

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