Long-term conditions and the National Diabetes Audit

The management of long-term conditions¹ in primary care has hit the headlines thanks to a report from the Academy of Medical Sciences,² which highlighted the clustering of different physical and mental health conditions in a single patient, and estimated that millions of Britons suffer from multimorbidity.

Diabetes is acknowledged as a condition where primary care clinicians should be well used to managing multimorbidity, and lessons may be learnt from this area. The National Diabetes Audit data³ provide practice-level measures of diabetes outcomes including the numbers achieving target HbA1c and those at elevated risk of complications. We have recently published⁴ multivariate analysis linking variation in these outcomes to the organisation of diabetes care.

There was a univariate relation between a higher percentage of ‘No’ responses to ‘satisfaction with level of support for all LTC’ and a lower proportion of T2DM patients hitting target glycaemic control (TGC). Practices in the highest decile of patient rating with 3.0% ‘No’ response to this question had 68% TGC versus the lowest decile of ratings with 27.3% ‘No’ response associated with only 64% TGC. Interpolation gave a 1% increase in the TGC proportion at GP practice level associated with a 5.9% decrease in ‘No’ response.

We have shown how ensuring that patients with LTC feel listened to, involved, and cared for is a key way to make a difference to their clinical outcomes. Patients’ perception of clinical care may be a significant determinant of clinical outcomes.