Checks and cheques : implementing a population health and recall system to improve coverage of patients with diabetes in a rural general practice

Identification of all diabetic patients in the population is essential if diabetic care is to be effective in achieving the targets of the St Vincent Declaration.¹ The challenge therefore is to establish population based monitoring and control systems by means of state of the art technology in order to achieve quality assurance in the provision of care for patients with diabetes. ^2,3 Disease management receives extensive international support as the most appropriate approach to organising and delivering healthcare for chronic conditions like diabetes.⁴ This approach is achieved through a combination of guidelines for practice, patient education, consultations and follow up using a planned team approach and a strong focus on continuous quality improvement using information technology. ^5,6 The current software (Medical Director) could not easily meet these requirements which led us to adopt a trial of Ferret. In designing this project we used change management⁷ and the plan, do, study, act cycle⁸ illustrated in Diagram 1.

Association between obesity and diabetes using nested linear models

A data source with 7260 cases from the prospective observational study was used. Cases included both sexes and age ranging between 20yr and 7Oyr. Chi-squared tests and linear models were used to examine the effects of age (linear and quadratic), sex, smoking habit (currently a smoker or non-smoker), presence or absence of type 2 diabetes on obesity as measured by body mass index (BMI) and waist to hip ratio (WHR). Both these measures of
obesity were significantly affected by age, sex and the presence of diabetes. Cases with diabetes were significantly more obese (10%) between the ages 40yr to 59yr compared to patients without diabetes. These results accentuate the need to further examine the association between age, diabetes and obesity and other risk factors with cardiovascular diseases.