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Overall quality of diabetes care in a defined geographic region: different sides of the same story.
Gorter, Kees; van Bruggen, Rykel; Stolk, Ronald; Zuithoff, Peter; Verhoeven, Rob; Rutten, Guy.
Afiliación
  • Gorter K; Department of General Practice, Julius Centre for Health Sciences and Primary Care, University Medical Centre Utrecht, Utrecht, the Netherlands.
Br J Gen Pract ; 58(550): 339-45, 2008 May.
Article en En | MEDLINE | ID: mdl-18482488
BACKGROUND: In diabetes care, knowledge about what is achievable in primary and secondary care is important. There is a need for an objective method to assess the quality of care in different settings. A quality-of-care summary score has been developed based on process and outcome measures. An adapted version of this score was used to evaluate diabetes management in different settings. AIM: To evaluate the quality of diabetes management in primary and secondary care in a defined geographic region in the Netherlands, using a quality score. DESIGN OF STUDY: Cross-sectional study. SETTING: Thirty general practices in the Netherlands. METHOD: A study of 2042 patients with type 2 diabetes (1640 primary care and 402 secondary care) was conducted. Quality of diabetes management was assessed by a score of process and outcome indicators (range 0-40). Clustering at practice level and differences in patient characteristics (case mix) were taken into account. RESULTS: At the outpatient clinic, patients were younger (mean age 64.1 years, standard deviation (SD)=12.5 years, versus mean age 67.1 years, SD=11.7, P<0.001), had more diabetes-related complications (macrovascular: 39.7% versus 24.3%, P<0.001; and microvascular: 25.9% versus 7.3%, P<0.001), and lower quality-of-life scores (EuroQol-5D: mean=0.60, SD=0.29, versus mean=0.80, SD=0.21, P<0.001). After adjusting for case mix and clustering, there was a weak association between the setting of treatment and haemoglobin A1c (primary care: mean 7.1%, SD=1.1, versus secondary care: mean 7.6%, SD=1.2, P<0.016), and between setting and systolic blood pressure (primary: mean 145.7 mmHg, SD=19.2, versus secondary care: 147.77 mmHg, SD 21.0, P<0.035). Quality-of-care summary scores in primary and secondary care differed significantly, with a higher score in primary care (mean 19.6, SD=8.5 versus, mean 18.1, SD=8.7, P<0.01). However, after adjusting for case mix and clustering, this difference lost significance. CONCLUSION: GPs and internists are treating different categories of patients with type 2 diabetes. However, overall quality of diabetes management in primary and secondary care is equal. There is much room for improvement. Future guidelines may differentiate between different categories of patients.
Asunto(s)

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Calidad de la Atención de Salud / Diabetes Mellitus Tipo 2 / Medicina Familiar y Comunitaria / Atención Ambulatoria Tipo de estudio: Clinical_trials / Evaluation_studies / Guideline / Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Br J Gen Pract Año: 2008 Tipo del documento: Article País de afiliación: Países Bajos

Texto completo: 1 Banco de datos: MEDLINE Asunto principal: Calidad de la Atención de Salud / Diabetes Mellitus Tipo 2 / Medicina Familiar y Comunitaria / Atención Ambulatoria Tipo de estudio: Clinical_trials / Evaluation_studies / Guideline / Observational_studies / Prevalence_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: Br J Gen Pract Año: 2008 Tipo del documento: Article País de afiliación: Países Bajos