Diabetes can be managed as well in primary care as in hospital
With government backing, over 90% of general practitioners in the
United Kingdom have assumed responsibility for the routine review of
their patients with diabetes, in spite of conflicting trial evidence.
On p 390 Griffin reviews randomised trials of general practice and
shared care versus hospital care for people with diabetes. Selected
primary care teams, when supported by a central computerised prompting
system for both doctor and patient, were able to achieve standards of
care as good as or better than hospital outpatient follow up in the
short term. Less well structured care in the community was associated
with poorer follow up, worse glycaemic control, and greater mortality
than hospital care. The evidence supports the provision of regular
prompted recall and review and shows that this can be achieved in
primary care.
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- Diabetes care in general practice: meta-analysis of randomised control trials • Commentary: Meta-analysis is a blunt and potentially misleading instrument for analysing models of service delivery
- Simon Griffin and Trisha Greenhalgh
BMJ 1998 317: 390-396.[Abstract] [Full Text] [PDF]
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