THE STUDY

there are no supplemental documents

REPORTING & ETHICS

I am not aware of a reporting statement for qualitative work

GENERAL COMMENTS

Summary:
The authors describe the output from a series of in-depth interviews with GPs and PNs in Ireland during the period 2009 to 2010. The focus of the interviews was to establish attitudes towards the roll out of a National Integrated Diabetes Care model. The participants were identified from an earlier survey of diabetes care provision in general practice and the sample was selected to include as wide an array of practice types as possible. The findings point to a lot of barriers (and a few facilitators) to the delivery of good quality diabetes care in general practice in Ireland. Among the major barriers are a lack of remuneration by the health service for chronic disease management delivered n general practice. Facilitators included a sense of (vocational) duty to deliver diabetes care among some GPs and pockets of good integrated care in some areas of the country.

Major comments:
The study population consisted of GPs who had opted in during a preceding postal survey on the organisation of diabetes care. What was the response rate to the postal survey and was there potential for bias with those with an interest in diabetes more likely to respond to the survey and also to opt in to taking part in an interview? At the beginning of methods section the authors state that the paper focuses on organisation of diabetes care and barriers and facilitators to optimal management. However, no information is really provided on how diabetes care is delivered in participating practices – it would be useful to have a background section to describe the practices that participated in the qualitative study eg whether diabetes care was delivered in a structured way or 'opportunistically'. The concept of 'in the meantime' care is not clearly explained and should be clarified. The quote relating to this theme in Box 3 does not help with understanding where the term came from. It may be that a different description of what the authors are trying to get across would be more appropriate. Likewise the term 'Lucky' as used to describe a theme coming from the interviews does not feel right. Does this refer to areas of the country where community services are more readily available or does it refer to areas of the country where services between community and hospital are better integrated? This should be clarified and consideration given to a different descriptor for this theme. Also it would be useful to define what is meant by a "vocational incentive". Figure 1 is complex and needs more than just a passing reference to it in the text. At a minimum a standalone figure legend should be included. How was this figure put together? It is not clear how the relationships between the different variables were established.

Minor comments:
On page 7, line 30 the word "free" should be removed. The second paragraph (beginning on line 19) on page 14 seems out of place and is probably not required.