Monitoring of elderly housebound and mobile diabetic patients in 31 Leicestershire practices: A comparative study

Abstract

The objective of this study was to compare the monitoring of housebound and mobile diabetic patients aged 75 years and over. In addition, a survey was undertaken to assess the views of health professionals on the results obtained from the study and the service provided to patients. Thirty-one volunteer general practices conducted a clinical audit of their diabetic patients using an audit protocol. They were then asked to identify which patients over the age of 75 years were housebound, using a standard definition provided to them. Results were analysed by the Primary Care Audit Group (PCAG) and the audit leads in each participating practice were asked to complete a questionnaire seeking their views on aggregated results and aspects of service provision. Data were collected on 682 mobile and 152 housebound diabetic patients aged 75 or over. The results indicate that housebound diabetic patients had significantly lower recorded standards of monitoring for each of seven key audit criteria, addressing annual assessment of symptoms, glycated haemoglobin, feet, urinalysis, fundi, blood pressure and smoking (p < 0.001). Twenty-eight (90.3%) of the audit leads returned the questionnaire and none of the respondents felt that housebound patients should attend hospital for monitoring. Respondents identified time and training as important resource issues for better monitoring in the community. Respondents also favoured the increased use of diabetic health visitors and domiciliary opticians and for nursing homes to take more responsibility for ensuring that their own patients were monitored.