The aim of this study was to obtain qualitative data to understand how type 2 diabetic patients with unregulated blood glucose levels (HbA1c >140 mg/dL) seek and use information sources for their diet.

A descriptive, explorative study design was used with focus group interviews in the Brussels-Capital Region. Each interview was recorded, transcribed literally, and analysed thematically using a grounded theory approach.

GPs were the most important information source in this study. GPs and other professionals were considered to be reliable sources of information by the patients. All patients received information passively at diagnosis. Patients that actively sought information differed in their search behaviour and reported they were not sufficiently informed. Some information sources remained unknown to the diabetic patients in this study.

Diabetic patients of the Brussels-Capital Region are not well informed about their diet. The main problem is how patients perceived the accessibility of information.

Public health strategies are required to promote well-informed, proactive patients supported by healthcare teams.

The need to improve the response of primary care in terms of identification of people with undiagnosed dementia has long been recognised. The role of Primary Care Liaison was identified as a possible solution. An in-depth consultation was undertaken to identify professional competencies required in executing such a role.

Comprehensive literature and policy reviews were conducted to establish draft competencies or different options/combinations of competencies and competency levels. Consultations with a wide range of professional stakeholders (n = 23) and over 70 users and carers were conducted through focus groups, electronic document circulation and telephone interviews. An Equality Impact Assessment was conducted concurrent to the consultation.

The literature demonstrated a clear need both to improve the rate of diagnosis for people with dementia and to improve the way in which the diagnosis is made. The stakeholder consultation repeatedly affirmed that without a diagnosis the person with dementia and their caregivers did not get access to the appropriate services, and validated the need for a role that would be able to improve a system that would deliver an early and ‘timely’ diagnosis. Competencies, based on the literature and policy documents, were developed and debated through the consultation processes.

Three main areas of competency were identified: counselling; screening; and health education and promotion. The competencies identified require a skilled experienced professional approach. A useful team model would be that the role is placed within a ‘GP cluster’ as accessibility to GP records and collaborative working with GPs is essential within the role. Personal continuing professional development has a high profile in maintaining these competencies.

In Sweden, quality indicators in health care have been the basis for developing National Quality Registers. The Swedish National Diabetes Register (NDR) – one of the largest diabetes registers globally – was introduced in primary health care (PHC) in the county of Östergötland by an implementation project, 2002–2005.

The aim of the present paper was to investigate, by using the results of the NDR, whether the registration led to sustained outcomes of medical results of diabetes care in PHC in the county during the period 2005–2009.

HbA1c, blood pressure (BP), albuminuria and low-density lipoprotein-cholesterol were registered online in the NDR. In 2005 and 2006, goal achievement for HbA1c was measured and compared between PHC centres (PHCC) within the county. In 2007, achievements to national goals were compared between the PHCCs within the county and with those Swedish counties that had attained a sufficiently high registration rate. In 2008 and 2009, the average county results were compared with the corresponding national average measurements for all 21 Swedish counties combined.

In 2005, a clear improvement trend for HbA1c and BP was shown within the county. In 2007–2009, goal achievements in the county studied were slightly better than the other counties measured and the country as a whole in almost every comparison.

The present study has shown association between medical results and registration in the NDR. As the project was primarily a quality improvement work, the results have continuously influenced the development of diabetes care. Both the health professions and the county council now have – in the NDR – an effective and rapid method for evaluation and follow-up of diabetes care. The systematic documentation, followed by comparisons and analyses, create ideas for care improvements.

This study aimed at exploring the experiences of primary health-care providers of their encounters with patients with type 2 diabetes, and their preferences and suggestions for future improvement of diabetes care.

Barriers to good diabetes care could be related to problems from health-care providers’ side, patients’ side or the health-care system of the country. Treatment of patients with type 2 diabetes has become a huge challenge in Oman, where the prevalence has increased to high levels.

Semi-structured interviews were conducted with 26 health-care professionals, 19 doctors and seven nurses, who worked in primary health care in Oman. Qualitative content analysis was applied.

Organizational barriers and barriers related to patients and health-care providers were identified. These included workload and lack of teamwork approach. Poor patients’ management adherence and influence of culture on their attitudes towards illness were identified. From the providers’ side, language barriers, providers’ frustration and aggressive attitudes towards the patients were reflected. Decreasing the workload, availability of competent teams with diabetes specialist nurses and continuity of care were suggested. Furthermore, changing professional behaviours towards a more patient-centred approach and need for health education to the patients, especially on self-management, were addressed. Appropriate training for health-care providers in communication skills with emphasis on self-care education and individualization of care according to each patient's needs are important for improvement of diabetes care in Oman.

The overall purpose was to develop, test and evaluate an educational package to help people with diabetes self-manage their risk of developing chronic kidney disease (CKD), one of the main complications of diabetes.

Management of people in primary care who have both CKD and diabetes can be controlled by strict blood pressure (BP) and blood sugar control and advice on lifestyle changes, such as smoking cessation. However, there is little evidence to support the assertion that self-management can slow the rate of kidney disease progression.

A mixed-method longitudinal study. Development of the self-management package was informed by the findings of a case study in six GP Practices and also through interviews with 15 patients.

Testing of the self-management package was undertaken in the same six Practices, with one additional control Practice. Patients with Type 1 or Type 2 diabetes at risk of kidney disease were included. Outcomes in patients in the participating surgeries who did receive a pack (n = 116) were compared with patients in the control group (n = 60) over 6 time points.

At the end of the study (time point 6), the intervention group had a mean systolic BP of 4.1 mmHg lower and mean diastolic BP of 2.7 mmHg lower than in the control group.

Self-management techniques such as understanding of, and subsequent concordance with, prescribed BP medication may contribute to a reduction in BP, which in turn will reduce cardiovascular risk.

Relevance to clinical practice: This study contributes to the evidence base for self-management of early kidney disease. Although the exact reason for reduced BP in the intervention group is unclear, the importance of practitioner understanding of kidney disease management and patient understanding of BP medication are likely to be the contributing factors.

This paper aims to explore and analyse mental healthcare staff's (MHCS) knowledge and experiences of diabetes care for persons with psychosis.

There are a range of studies concerning the increased risk of type 2 diabetes mellitus among persons with psychosis, and the need for healthy lifestyle interventions to prevent the illness. MHCS are often trusted and have regular follow-ups with the patients, and their attitudes and actions often play an important role for the person's care behaviour. There is still little documentation of their experiences of diabetes care.

A qualitative, explorative design was used, collecting data through semi-structured interviews with 12 MHCS working in psychosis outpatient care in Sweden. Data were analysed with qualitative content analysis.

Three categories emerged and provide a deeper understanding of how staff were aware of the risks of type 2 diabetes among their patients and therefore performed lifestyle interventions to promote these. Nevertheless, they lacked knowledge of diabetes care and simultaneously felt a lack of training among diabetes nurses to adapt diabetes care to suit persons with cognitive dysfunctions. Patients who were overconfident in their ability to manage diabetes care reported to have experienced most difficulties. Cooperation among those involved in these persons’ health was considered necessary.

Diabetes care for persons with psychosis could improve if knowledge of type 2 diabetes was increased among MHCS and training in how to adapt diabetes care to persons with cognitive dysfunctions was enlarged among diabetes nurses. A challenge for nurses is to see how the care of different illnesses and support given by the family and others affect the persons total life situation and health. Healthcare plans and cooperation among all those involved in these persons’ health is necessary for this.

To explore the views of individuals recently diagnosed with type 2 diabetes in relation to self-management of dietary intake and physical activity, and to compare these with the views of health professionals (HPs).

Diabetes education has become a priority area in primary and secondary care, and many education programmes are now embedded within a patient's care package. There are few contemporaneous explorations of patients’ views about lifestyle self-management. Such research is vital in order to identify areas that require further support, refinement or enhancement in terms of patient education.

Focus groups were held with patients recently diagnosed with type 2 diabetes (n = 16, 38% female, aged 45–73 years). In-depth semi-structured interviews were conducted with HPs (n = 7). Discussions focussed on self-management specifically in relation to making dietary and physical activity changes. All discussions were tape recorded, transcribed and analysed by emergent themes analysis using NVivo to manage the coded data.

Barriers were divided into six main categories: difficulty changing well-established habits, negative perception of the ‘new’ or recommended regimen, barriers relating to social circumstances, lack of knowledge and understanding, lack of motivation and barriers relating to the practicalities of making lifestyle changes. HPs generally echoed the views of patients. In conclusion, even against a background of diabetes education, recently diagnosed patients with type 2 diabetes discussed a wide range of barriers to self-management of diet and physical activity. The findings could help to provide HPs with a deeper understanding of the needs of recently diagnosed patients and may help refine current diabetes education activities and inform the development of educational resources.

To determine Citizen's Advice Bureaux (CAB) and general practice staff perceptions on the impact of a CAB Health Outreach (CABHO) service on staff workload. To quantify the frequency of mental health issues among patients referred to the CABHO service. To measure any impact of the CABHO service on appointments, referrals and prescribing for mental health.

GPs and practice managers perceive that welfare rights services, provided by CAB, reduce practice staff workload, but this has not been quantified.

Interviews with practice managers and GPs hosting and CAB staff providing an advisory service in nine general practices. Comparison of frequency of GP and nurse appointments, mental health referrals and prescriptions for hypnotics/anxiolytics and antidepressants issued before and after referral to the CABHO service, obtained from medical records of referred patients.

Most GPs and CAB staff perceived the service reduced practice staff workload, although practice managers were less certain. CAB staff believed that many patients referred to them had mental health issues. Data were obtained for 148/250 referrals of whom 46% may have had a mental health issue. There were statistically significant reductions in the number of GP appointments and prescriptions for hypnotics/anxiolytics during the six months after referral to CABHO compared with six months before. There were also non-significant reductions in nurse appointments and prescriptions for antidepressants, but no change in appointments or referrals for mental health problems. The quantitative findings therefore confirmed perceptions among both CAB and practice staff of reduced workload and in addition suggest that prescribing may be reduced, although further larger-scale studies are required to confirm this.