Perceived strategic and practical problems in the use of information technology for quality improvement in diabetes care in the United Kingdom.

Quality Assurance in Diabetes Care is a new aspect of our National Health Service Reforms linked to the publication of a Patient's Charter. If current pressures are maintained, most diabetics in UK will soon receive their diabetes care from their General Practitioner, often based in a Group Practice where structured care for chronic diseases is more easy to organise. Large inner cities like London have special problems not adequately addressed in resource allocation. Penetration of computers into General Practice is forecast in many areas to be approaching 100% within the next two years but few systems will be able to provide useful support for structured diabetes care. Organisational issues concerning treatment protocols, contracts for care, quality assessment and audit are daunting and will take time to agree and install. The British Diabetic Association and The Royal College of Physicians have a joint initiative in developing a National Audit Dataset for Diabetes Care which is compatible with WHO's DiabCare. Current information systems in hospital and community care are inadequate to monitor the St Vincent "End points" and it is unlikely that things will improve sufficiently quickly to either facilitate or document progress towards the St Vincent Objectives. The Government have not included diabetes in their strategic plans for the next five years. As a result, it seems unlikely that Diabetes Care in the UK will meet the St Vincent Objectives by 1995.