Rapid assessment methods used for health-equity audit: Diabetes mellitus among frail British care-home residents

Summary 

Background

To perform a health-equity audit of diabetes care among elderly care-home residents.

Study design

Health-need assessment using rapid-evaluation methods.

Setting

Residents of care homes in Newcastle upon Tyne, UK.

Participants

All care-home residents in the city.

Outcome measures for diabetes

To carry out health-need assessment, agree partners and issues, assess equity profile, and to agree high-impact local action to narrow the gap, according to the guidance on health-equity audit provided by the Department of Health.

Results

A combination of qualitative and quantitative methods were used to develop a methodology to complete the health-need assessment component of the health-equity audit. A number of criteria for an appropriate standard of care, and how the current service met these standards, were reported in a timely fashion to the primary care trust. The domains comprised national standards for care, diabetes prevalence, adequacy of coverage and standard of care delivered, and environment, including availability of equipment and knowledge and attitudes of care staff. The output was structured to identify a number of key issues: the diabetes register under-represents the number of cases of known diabetes mellitus (3.5% vs. 11.5%); weights and blood-pressure measurements were incorporated into the care-home environment; this population had inappropriately high rates of glucose monitoring, secondary care involvement and little evidence of co-ordinated eye screening; and staff needed training for diabetes care, which they recognized. Finally, recommendations were agreed for the immediate response and a local action plan agreed to narrow the health gap.

Conclusions

It is feasible to use rapid-evaluation methodologies to initiate a health-equity audit of current diabetes services for care-home residents in a large health district, informing the primary care trust about health equity for this vulnerable group of patients. The tools developed can be used again to inform the iterative process of health-equity audit in the future. We would recommend the use of these methods and similar combined qualitative/quantitative techniques as valuable alternatives for a health-equity audit in the absence of extensive databases on which to assess health equity.

Keywords: Diabetes mellitus, Health-equity audit, Health Needs Assessment, Nursing homes