Reducing Variability and Improving Diabetes Care
Research type
Research Study
Full title
Reducing Variability and Improving Diabetes Care in General Practices in Deprived and Ethnic Areas
IRAS ID
189080
Contact name
Joseph Paul O'Hare
Contact email
Sponsor organisation
University Hospitals Coventry & Warwickshire NHS Trust
Duration of Study in the UK
2 years, 5 months, 30 days
Research summary
Diabetes is a growing problem producing an expensive challenge with its treatment and a major demand on healthcare resources and hospitalisations for its complications.
For many years performance indicators have been collected with detail down to practice level. These show considerable variation in performance across the country and within commissioning groups across their practices. In Coventry and Rugby CCG for example, the variation in achieving the guideline blood pressure target varies from 25% for worst to 90% for best.
Publication of these performance statistics and inclusion of the many targets in the Quality Outcomes Framework Scheme in general practice has improved overall outcomes after its initial introduction. The effect was much greater in practices in affluent areas and recent publications have shown that the initial improvements have not been sustained.
The research innovation we plan to bring to our newly established Specialist Diabetes in the Community Service (SDCS) is to produce an intervention derived from all the research carried out across the world that will support the 20 % of practices in Coventry with the most deprived patient population often associated with multi-ethnicity.
The intervention will be multi-factorial but it aims to address the four critical features of successful interventions in providing diabetes care i.e. case finding and management, team changes, patient education and self-management and professional education.
It is planned to switch manpower resources from hospital to the community and to have a multi-disciplinary team of diabetes consultant, specialist nurse and dietician working with 8 of the most deprived practices in Coventry over 12 months. They will use Eclipse, a software management system to case find and manage working with the practice team.
Because this innovation is new we plan to carry out a full qualitative assessment and to collect performance indicators on a before and after basis and to include a randomised control group which is the only way to counter the possibility of temporal change. This study could act as a pilot for testing this innovation on a larger scale and locally should inform commissioners about decisions on what to support.
The role of the community pharmacist and link workers to act as a bridge to assist with the empowerment of the ethnic minorities is a novel part of the bid and a key team player to help deal with the cultural and accessibility issues of the elderly patients from ethnic subgroups. This role will also assist clinicians in the most appropriate treatment option.
REC name
West Midlands - Solihull Research Ethics Committee
REC reference
16/WM/0074
Date of REC Opinion
25 Apr 2016
REC opinion
Further Information Favourable Opinion