Ray O'Connor

Diabetes mellitus in Irish general practice: Level of care as reflected by HbA1c values

Objective: To assess the level of care given to people with diabetes by general practitioners and factors affecting it. Methods: A cross-sectional study of Irish general practitioners, looking at practice characteristics and patient care over the previous 2 years; a nationally representative sample of 27 general practitioners. A total of 1030 people with diabetes were studied, of whom 201 were type 1 and 829 were type 2. Results: The response rate was 27 out of 52 (52%). HbA1c values were not related to the patients socioeconomic status. The average HbA1c for type 1 people with diabetes was 7.81%, and for type 2 it was 7.1%. HbA1c values were measured 3.02 times for type 1 and 3.16 times for people with type 2 diabetes. This is a good standard of care, especially for type 2 disease. Computerized practices and those patients whose care was shared with the hospital achieved better control, even though HbA1c levels were checked less frequently with computerization. The use of a protocol in the practices also improved care. Those practices employing a nurse had increased frequency of measurement of HbA1c and better control on univariate but not on multivariate analysis. Possible reasons for this are discussed. Conclusion: Diabetes Mellitus is treated to a good standard in Irish general practice, especially type 2 disease. This standard appears to be independent of the patients socio-economic status, is improved by GPs being computerised, in group practices and by providing care according to a protocol. Shared care also improves control. Employing a practice nurse may also improve care.

Youth mental health in deprived urban areas: a Delphi study on the role of the GP in early intervention

BackgroundGPs, as healthcare professionals with whom young people commonly interact, have a central role in early intervention for mental health problems. However, successfully fulfilling this role is a challenge, and this is especially in deprived urban areas.AimsTo inform a complex intervention to support GPs in this important role, we aim to identify the key areas in which general practice can help address youth mental health and strategies to enhance implementation.MethodsWe conducted a modified Delphi study which involved establishing an expert panel involving key stakeholders/service providers at two deprived urban areas. The group reviewed emerging literature on the topic at a series of meetings and consensus was facilitated by iterative surveys.ResultsWe identified 20 individual roles in which GPs could help address youth mental health, across five domains: (1) prevention, health promotion and access, (2) assessment and identification, (3) treatment strategies, (4) interaction with other agencies/referral, and (5) ongoing support. With regard to strategies to enhance implementation, we identified a further 19 interventions, across five domains: (1) training, (2) consultation improvements, (3) service-level changes, (4) collaboration, and (5) healthcare-system changes.ConclusionsGPs have a key role in addressing youth mental health and this study highlights the key domains of this role and the key components of a complex intervention to support this role.

‘Nobody really gets it’: a qualitative exploration of youth mental health in deprived urban areas

To examine the experience of developing and living with mental health and substance use disorders among young people living in urban‐deprived areas in Ireland to inform primary care interventions.