Effect of structured postgraduate medical education on the care of patients with diabetes.

Diabetes can be effectively treated and monitored in general practice. Postgraduate medical education at a local level is required to support this strategic shift of medical care from hospital to general practice. This study set out to determine whether a structured educational programme initiated by and led by general practitioners, but involving all health professionals, leads to improved care for diabetic patients. The primary health care teams from 12 of the general practices in Tynedale, Northumberland who attend the local postgraduate centre and refer patients to the local general hospital were involved in the educational initiative which led to a locally agreed protocol for diabetic care. A comparison was made of data for all diabetic patients, registered with the general practitioners in 1991, in the years 1986 and 1991 (before and after the educational initiative) in order to determine the prevalence of diabetes, place of care and treatment received, and to collect clinical information. More patients received general practice care only or shared care in 1991 than in 1986. There was a reduction in the use of oral hypoglycaemic agents among non-insulin dependent diabetic patients and more patients were maintained on diet alone. A greater proportion of patients were referred to dietitians, ophthalmologists and chiropodists in 1991 than 1986, and there was increased recording of, examination of, and identification of, diabetic complications. Little change was found in the mean values for clinical parameters between the two years. Structured educational programmes involving all professionals are an effective way of producing protocols that are adhered to by all concerned, and lead to improved clinical care for diabetic patients.