Content of review 1, reviewed on May 28, 2013
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.
Source
© 2013 the Reviewer (source).
Reviewed on June 29, 2013
Source
© 2013 the Reviewer (source).