An investigation of the relationship between routine care for diabetes and hospital use
2014-12-15T10:31:11Z (GMT) by
There is very limited evidence available on the impact of changes in diabetes care at the interface between general practice and hospital based services. It seems pertinent to ask whether hospital resources could be saved through earlier identification of problems and better management producing reductions in hospital admissions. An alternative, and equally credible, scenario is that improving identification and surveillance of individuals with diabetes will increase the number of referrals to hospitals for investigation and treatment of identified problems. It is therefore important to critically examine the current predictors of admission. This will help to predict future patterns of demand and the impact of further changes in the organisation of care.;There is currently another reason for interest in factors which predict admission rates. Admission rates for acute long-term diabetic complications represent a useful, routinely available outcome reflecting overall quality of diabetes services and could be used to assess services.;The major purpose of this thesis therefore is to address the issue of whether a process of routine regular review may influence the risk of hospital admission or attendance at the accident and emergency department for an individual with diabetes. The new chapter sets out the aims and objectives in more detail. The available evidence for suggesting that changes in organisation of diabetes care may influence admission rates and the extensive literature on determinants of hospital admission have been examined (Chapter 3). Initially, a pilot study was conducted which resulted in some significant changes to the study methodology (Chapter 4). For the main study, data from 1120 individuals with diabetes from seven different practices were collected and analysed (Chapters 5 to 10). A comparative study of accident and emergency department use by individuals with diabetes was also conducted (Chapter 11). The final chapter (Chapter 12) brings together some conclusions from these studies and proposes some potentially fertile areas for further research.