Effect of an educational intervention in primary care physicians on the compliance of indicators of good clinical practice in the treatment of type 2 diabetes mellitus [OBTEDIGA project].

AIM: To evaluate the effect of an educational intervention among primary care physicians on several indicators of good clinical practice in diabetes care. METHODS: Two groups of physicians were randomly assigned to the intervention or control group (IG and CG). Every physician randomly selected two samples of patients from all type 2 diabetic patients aged 40 years and above and diagnosed more than a year ago. Baseline and final information were collected cross-sectionally 12 months apart, in two independent samples of 30 patients per physician. The educational intervention comprised: distribution of educational materials and physicians' specific bench-marking information, an on-line course and three on-site educational workshops on diabetes. External observers collected information directly from the physicians and from the medical records of the patients on personal and family history of disease and on the evolution and treatment of their disease. Baseline information was collected retrospectively in the control group. RESULTS: Intervention group comprised 53 physicians who included a total of 3018 patients in the baseline and final evaluations. CG comprised 50 physicians who included 2868 patients in the same evaluations. Measurement of micro-albuminuria in the last 12 months (OR = 1.6, 95% CI: 1.1-2.4) and foot examination in the last year (OR = 2.0, 95% CI: 1.1-3.6) were the indicators for which greater improvement was found in the IG. No other indicator considered showed statistically significant improvement between groups. CONCLUSIONS: The identification of indicators with very low level of compliance and the implementation of a simple intervention in physicians to correct them is effective in improving the quality of care of diabetic patients.

Quality of care of patients with type-2 diabetes in Galicia (NW Spain) [OBTEDIGA project].

AIMS: The aim of this study was to describe the degree of compliance of agreed practices with reference to primary care patients with Type 2 diabetes of 40 years old and older in Galicia (NW Spain). METHODS: A total of 108 primary care physicians were selected at random from the totality of doctors. Each physician selected 30 patients at random from their patients suffering from diabetes of 40 years old or older. External observers gathered information from each patient's medical record regarding their characteristics, condition and degree of compliance of selected indicators of good practice. RESULTS: Group of physicians participated in this study had a mean age of 50 years (standard deviation = 3.9); 48% of them were females; and 17.5% involved in medical residents training. A total of 3078 diabetic patients were included in the study: mean age = 69 years (SD = 10.9), 47.6% women, presence of high blood pressure (72%), hypercholesterolaemia (56%), and regular smokers (10.3%). Compliance with selected indicators such as foot examination (14%), ophthalmological examination (30.6%), abdominal circumference measurement (6.1%), measurement of total or LDL-cholesterol (78.1), blood pressure measurement (84.8), glycosylated haemoglobin measurement < 7% (54.3%) was observed. Adequate monitoring in cases of high blood pressure and hypercholesterolaemia were 34.2% and 27.4%, respectively. Variability between physicians differs according to the different indicators, with interquartile range for compliance of between 16.4 and 66%. CONCLUSIONS: There is a wide margin for improvement in the adaptation of clinical practice to recommendations for diabetic patients. The large variation existing in certain indicators would suggest that certain control objectives are less demanding than advisable in those that comply least, while low compliance and low variability in other indicators point to structural problems or unsatisfactory training of doctors.

[Iodine deficiency disorder persistance after introduction of iodized salt in a previously endemic goiter area]. / Persistencia de un trastorno por déficit de yodo tras la introducción de sal yodada en un área con antecedentes de bocio endémico.

OBJECTIVE: Correction of iodine deficiency diminishes the incidence of toxic nodular goitre. The aim of this study was to assess the etiology of thyrotoxicosis in two areas with different goitre prevalence in Galicia, fifteen years after the institutional campaign of salt iodination. Results of the present survey are compared with those from a study performed ten years ago. METHODS: Two hundred and two thyrotoxic patients attended in La Coruña (coastal zone) and Lugo (inland zone) from January 2000 to May 2002 were included. Clinical and exploratory data were recorded. Thyroid hormones, thyroid-directed antibodies and thyroid stimulating immunoglobulin (TSI) were measured. A thyroid 99m technetium or 123 iodine scintigram was performed. RESULTS: In the whole group 58.6% of the cases were diagnosed of nodular goitre, 30.3% of Graves disease, 7.1% of iodine induced thyrotoxicosis and 3.5% of subacute thyroiditis. In coastal zone these percentages were 52.2, 37.0, 5.4 and 4.3%, respectively. In the inland area, 64.2% nodular goitre, 24.5% Graves disease, 8.5% iodine induced thyrotoxicosis and 2.8% subacute thyroiditis. The most frequent diagnosis in both the whole group and in each area was toxic multinodular goitre. CONCLUSIONS: In some areas of Spain, toxic nodular goitre continues to be the most frequent cause of thyrotoxicosis. It is necessary to insist on implementation and monitoring of iodine supplementation programs.