Diabetes care in Ireland: A survey of general practitioners

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.