Diabetes in Northern Ireland : using routine health care data to inform public health care policy

• Main Author: Gallagher, Naomh
• Published: Queen's University Belfast 2013
• Subjects: 362.196462009416
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.601482

Diabetes is a leading cause of morbidity and mortality around the world, and the prevalence is increasing dramatically. Rather surprisingly, there is no consensus regarding the burden of diabetes in Northern Ireland. This thesis outlines the creation and utilisation of a novel centrally collated population wide dataset of dispensed prescriptions known as the Enhanced Prescribing Data base (EPO). This was successfully used, together with linkage of other demographic and health-related data, to provide estimates of the prevalence, incidence and changing prevalence of diabetes in Northern Ireland over a three year period, and of the associated relative mortality risk for patients with diabetes. Through further linkage to unique and individual-level indicators of socioeconomic status, a comprehensive picture of the differential burden of diabetes across society was produced. Variation related to geography, demographics, socioeconomic variables, and over time was investigated. In addition, the thesis demonstrates how routine administrative data can be used to investigate the relationship between health policy and diabetes ca re. This was outlined in two studies; the first, using a time series analysis, showed how the introduction of financial incentives for GPs in the UK, , , through the Quality and Outcomes Framework (QOF) initiative changed the care of t he approximately 30% of patients with type 2 diabetes who are usually managed non• pharmacologically. The second study demonstrated how use of routine data can be used to undertake comparative analysis of patients with diabetes in Northern Ireland and the Republic of Ireland (two similar populations with distinct health systems) to the potentially mutual benefit of both jurisdictions. This thesis provides both a novel methodology to estimate diabetes in Northern Ireland, and a number of unique examples of how administrative datasets and record linkage can be successfully utilised to answer important and policy Relevant questions in diabetes and heather services research.