Primary care, secondary care or both: is there a consensus on long term management of diabetes mellitus?

The aim of this study was to test the hypothesis that specific referral guidelines are unhelpful because of wide variations in individual clinical practice.

A series of representative diabetes case studies were given to a group of primary care, general practice (GP) clinicians for comment. The same cases were given to a group of secondary care clinicians. The suggested management strategies were compared.

Overall the results show very little agreement among either primary care or secondary care clinicians for a series of commonly presenting clinical cases. Approximately a third of GP responses for each group of cases suggested primary care management with a third each split between secondary or shared care. Long term follow up of the cases was also disputed but a greater proportion felt that continuing specialist input would not be required. Patient choice was not considered an important factor in deciding the most appropriate place for care.

Although specific management strategies would be helpful for service planners, in reality clinicians differ greatly in what they feel should be managed in primary or secondary care. This variability needs to be considered in future planning for long term conditions such as diabetes. Copyright © 2009 John Wiley & Sons, Ltd.