Public health

Performance report: room for GPs to improve management of diabetes

This first annual report on 10 Quality Improvement Measures (QIM) from the national Practice Incentives Program (PIP) for GPs has highlighted where improvements can be made in the management of diabetes.

The report from the Australian Institute of Health and Welfare found about 60% of people with type 1 diabetes and 75% of people with type 2 diabetes have their HbA1c recorded annually in their regular GP record.

This is despite guidance recommending HbA1c measurement at least annually, or more often depending on the level of blood glucose control.

The first year of data from the program during 2020-2021 comes from 5,700 GP practices.

The report found the rates of HbA1c measurement varied across the primary health networks from 49.0% to 69.4% for type 1 and 66.5% to 82.1% for type 2 diabetes.

In both conditions, older adults ≥65 years were much more likely to have HbA1c recorded than younger age groups.

The report also found 58.7% of patients with diabetes had blood pressure recorded in their GP record within 6 months prior to July 2021.

The findings suggest GPs do not have the necessary data to calculate CVD risk assessment for primary prevention.

However the rate has improved by a modest 6.7% since first measurements in October 2020.

Recording of influenza vaccination status in the GP record for people was diabetes was also sub-optimal at 58.2% considering strong recommendations for vaccination in people with chronic metabolic disorders.

The rate varied from 42.0% to 68.7% across primary health networks.

The report also found that less than a quarter (23.6%) of regular GP clients aged 15 years and over had their height and weight measurements recorded in their GP record within the previous 12 months.

Of those who did, 39.8% had a BMI in the obese range and 32.5% in the overweight range.

The Practice Incentives Program (PIP) Quality Improvement (QI) Incentive, launched in August 2019, is a payment to general practices to encourage participation in quality improvement activities, aimed at providing improved outcomes for clients through the delivery of high-quality care.

A similar ‘pay for performance’ program launched in the UK in 2004 was initially hailed for driving improvement in key care measures for people with diabetes. However the Quality Outcomes Framework (QOF) scheme was later criticised for becoming a bureaucratic box ticking exercise and was dismantled in some areas.

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