Missingness in type 2 diabetes monitoring within a Deep-End practice

Background Diabetic monitoring is essential to prevent complications. Uptake is low in areas of socioeconomic deprivation. As a result, ‘missing’ patients are at greater risk of poorer health outcomes and multimorbidity due to social inequalities. Understanding reasons for non-attendance is crucial to overcoming barriers, improving uptake of monitoring, and reducing multimorbidity. Aim This quality improvement project aimed to compare engagement in annual diabetic reviews between Port Glasgow Medical Centre (PGMC), a Deep-End practice, and a less deprived local practice. We aimed to improve uptake of monitoring and understand barriers to attendance. Method The SCI-Diabetes Scotland database provided quantitative data for both practices on the National Institute for Health and Care Excellence’s nine key care processes. Interventions included text or phone-call reminders and targeted patient education. Follow-up was completed after 6 months. Qualitative analysis using interviews explored patients’ perceptions of disease monitoring and barriers to attendance. Results Initial data demonstrated poorer uptake of diabetic monitoring at PGMC than the comparator practice with 13.1% completion of all key care processes compared with 32.6% respectively. This improved to 29.6% for PGMC after intervention, as did glycaemic control in newly diagnosed patients, blood pressure control, and smoking cessation. Barriers to attendance included poor health literacy, fear of discovering additional health problems, and underestimating the importance of monitoring. Conclusion Poor uptake of diabetic monitoring is more common in socioeconomically deprived areas. Competing priorities and poor health literacy are major contributors. Interventions focusing on patient education and targeted contact can improve uptake of diabetic monitoring, thus support earlier intervention and reduce multimorbidity.