Challenges in managing elderly people with diabetes in primary care settings in Norway.

OBJECTIVE: To explore the experiences and clinical challenges that nurses and nursing assistants face when providing high-quality diabetes-specific management and care for elderly people with diabetes in primary care settings. DESIGN: Focus-group interviews. SUBJECTS AND SETTING: Sixteen health care professionals: 12 registered nurses and four nursing assistants from nursing homes (10), district nursing service (5), and a service unit (1) were recruited by municipal managers who had local knowledge and knew the workforce. All the participants were women aged 32-59 years with clinical experience ranging from 1.5 to 38 years. RESULTS: Content analysis revealed a discrepancy between the level of expertise which the participants described as important to delivering high-quality care and their capacity to deliver such care. The discrepancy was due to lack of availability and access to current information, limited ongoing support, lack of cohesion among health care professionals, and limited confidence and autonomy. Challenges to delivering high-quality care included complex, difficult patient situations and lack of confidence to make decisions founded on evidence-based guidelines. CONCLUSION: Participants lacked confidence and autonomy to manage elderly people with diabetes in municipal care settings. Lack of information, support, and professional cohesion made the role challenging.

Quality of care for patients with type 2 diabetes in primary care in Norway is improving: results of cross-sectional surveys of 33 general practices in 1995 and 2005.

OBJECTIVE: To assess changes in the quality of care in Norway for patients with type 2 diabetes. RESEARCH DESIGN AND METHODS: Two cross-sectional surveys were examined that identified all patients (n = 1,470 in 1995 and n = 2,699 in 2005) with type 2 diabetes attending 33 general practices in 1995 and 2005. RESULTS: Between 1995 and 2005, there were significant improvements in the proportion of patients for whom important laboratory analyses, smoking habits, height, weight, and referral to eye examination were recorded. Mean A1C declined from 7.74 to 7.15%, systolic blood pressure from 150.0 to 140.4 mmHg, and cholesterol from 6.28 to 5.0 mmol/l (P < 0.001, age and sex adjusted). The 10-year risk of coronary heart disease for an average male patient declined from 42 to 29%. CONCLUSIONS: There have been substantial improvements in type 2 diabetes primary care in Norway that are potentially related to major improvements in health outcomes.

[Quality of diabetes care in Norwegian general practice]. / Kvaliteten på diabetesbehandlingen i allmennpraksis.

BACKGROUND: The prevalence of diabetes is increasing. Good diabetes care reduces macro and microvascular complications. Quality of care was assessed against predefined review criteria based on key recommendations in national guidelines MATERIAL AND METHODS: A cross-sectional study from four geographical areas in Norway, with electronic identification of all patients with diabetes mellitus and extraction of data from electronic patient records. All data were manually validated. RESULTS: 6892 patients with diabetes were identified, 5817 were cared for by the GPs and included in the study. 354 (6.0%) were classified as having type 1 diabetes and 5463 (94.0%) as type 2. For patients with type 1 mean Hb A1c was 7.8% and mean blood pressure 129/76 mm Hg; for type 2 the results were 7.1% and 139/79 mmHg. Among patients with type 2 diabetes and known cardiovascular disease, 69.7% were treated with statins and 60.6% with acetylsalicylic acid. About 90% of the study population had measured Hb A1c , blood pressure and lipids annually. 71% of patients with type 2 diabetes were referred to eye examination, smoking habits and weight were recorded in 57 and 54 % and urine albumin in 40% of the patients. INTERPRETATION: The quality of care had improved substantially in 2005 from five and 10 years ago (when similar studies were performed), although 80 % of patients did not reach the combined treatment targets for Hb A1c , systolic blood pressure and total cholesterol.

[Risk intervention in persons with diabetes mellitus in general practice]. / Risikointervensjon ved diabetes i allmennpraksis.

BACKGROUND: Intervention against cardiovascular risk factors such as hypertension, dyslipidaemia and smoking is necessary to reduce the increased mortality associated with diabetes mellitus. METHODS: The case notes of 2003 patients with diabetes in general practice in Rogaland, Salten and Aker were reviewed in order to assess the quality of diabetes care including the treatment of risk factors for cardiovascular disease. RESULTS: 287 out of 1417 patients below the age of 76 had known cardiovascular disease. Of these, 57.5% were treated with a statin and 61 % were taking aspirin. 118 patients had had a myocardial infarction, 69.5% were on a statin and 60.2% were taking aspirin. 776 (38.7%) of the patients in the study had been diagnosed as suffering from hypertension, 40.3% were on therapy with one anti-hypertensive agent, 28.6% received two agents and 12.1% were on three or more anti-hypertensive agents. Only 57.5% of patients, who according to current national guidelines ought to be on a statin as secondary prevention, received such a treatment. Smoking habits were recorded in 35.1% and weight in 45 % of the patients. INTERPRETATION: There is considerable room for improvement with regard to intervention against known risk factors for cardiovascular disease in patients with diabetes treated in primary care.