Overall quality of diabetes care in a defined geographic region: different sides of the same story

Gorter, Kees J.; Bruggen, Rykel van; Stolk, Ronald P.; Zuithoff, Peter; Verhoeven, Rob; Rutten, Guy E.H.M.

doi:10.3399/bjgp08x280209

Cited by 18 publications

(5 citation statements)

References 16 publications

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“…Our findings are in line with previous studies on T2D reporting that specialists often see younger individuals that are more likely to be men with more vascular complications and higher HbA 1c levels living in urban centres. [17][18][19] Individuals treated in specialist care are more likely to be monitored according to guidelines, with achievement of adequate HbA 1c levels [19][20][21][22] ; the last stands in contrast to our findings of higher HbA 1c levels in specialist care. Whether follow-up in specialist care positively affects HbA 1c , hypertension, vascular complications or improves survival is unclear, as results are conflicting.…”

Section: Discussioncontrasting

confidence: 84%

Factors associated with treatment in primary versus specialist care: A population‐based study of people with type 2 and type 1 diabetes

et al. 2021

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Section: Discussioncontrasting

confidence: 84%

Factors associated with treatment in primary versus specialist care: A population‐based study of people with type 2 and type 1 diabetes

et al. 2021

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“…However, differences in healthcare organization structure and variations in measurement of process of care indicators limit the scope of such comparisons. Most published results have included self-reported data which point to better item-by-item outcomes for blood pressure, lipid and HbA1C controls than for annual eye assessment, microalbuminuria check, feet examination, and influenza vaccination [8,10,12,16,33-35]. Similar indices were found by the European Core Indicators in Diabetes (EUCID) project, which gathered representative regional or national quality of care data over 19 countries [5].…”

Section: Discussionmentioning

confidence: 99%

Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey

Peytremann‐Bridevaux

Bordet

Burnand

2013

BMC Health Serv Res

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BackgroundWhile Switzerland invests a lot of money in its healthcare system, little is known about the quality of care delivered. The objective of this study was to assess the quality of care provided to patients with diabetes in the Canton of Vaud, Switzerland.MethodsCross-sectional study of 406 non-institutionalized adults with type 1 or 2 diabetes. Patients’ characteristics, diabetes and process of care indicators were collected using a self-administered questionnaire. Process indicators (past 12 months) included HbA1C check among HbA1C-aware patients, eye assessment by ophtalmologist, microalbuminuria check, feet examination, lipid test, blood pressure and weight measurement, influenza immunization, physical activity recommendations, and dietary recommendations. Item-by-item (each process of care indicator: percentage of patients having received it), composite (mean percentage of recommended care: sum of received processes of care / sum of possible recommended care), and all-or-none (percentage of patients receiving all specified recommended care) measures were computed.ResultsMean age was 64.4 years; 59% were men. Type 1 and type 2 diabetes were reported by 18.2% and 68.5% of patients, respectively, but diabetes type remained undetermined for almost 20% of patients. Patients were treated with oral anti-diabetic drugs (50%), insulin (23%) or both (27%). Of 219 HbA1C-aware patients, 98% reported ≥ one HbA1C check during the last year. Also, ≥94% reported ≥ one blood pressure measurement, ≥ one weight measurement or lipid test, and 68%, 64% and 56% had feet examination, microalbuminuria check and eye assessment, respectively. Influenza immunization was reported by 62% of the patients.The percentage of patients receiving all processes of care ranged between 14.2%-16.9%, and 46.6%-50.7%, when considering ten and four indicators, respectively. Ambulatory care utilization showed little use of multidisciplinary care, and low levels of participation in diabetes-education classes.ConclusionsWhile routine processes-of-care were performed annually in most patients, diabetes-specific risk screenings, influenza immunization, physical activity and dietary recommendations were less often reported; this was also the case for multidisciplinary care and participation in education classes. There is room for diabetes care improvement in Switzerland. These results should help define priorities and further develop country-specific chronic disease management initiatives for diabetes.

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“…One explanation for this could be a failure to reach guideline treatment targets. Indeed, several studies have shown that targets for blood pressure, glycemic control, and Low Density Lipoprotein (LDL) cholesterol are not reached in a large number of patients [ 4 , 5 , 6 , 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

Integrated Assessment of Pharmacological and Nutritional Cardiovascular Risk Management: Blood Pressure Control in the DIAbetes and LifEstyle Cohort Twente (DIALECT)

et al. 2017

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Cardiovascular risk management is an integral part of treatment in Type 2 Diabetes Mellitus (T2DM), and requires pharmacological as well as nutritional management. We hypothesize that a systematic assessment of both pharmacological and nutritional management can identify targets for the improvement of treatment quality. Therefore, we analysed blood pressure (BP) management in the DIAbetes and LifEstyle Cohort Twente (DIALECT). DIALECT is an observational cohort from routine diabetes care, performed at the ZGT Hospital (Almelo and Hengelo, The Netherlands). BP was measured for 15 min with one minute intervals. Sodium and potassium intake was derived from 24-hour urinary excretion. We determined the adherence to pharmacological and non-pharmacological guidelines in patients with BP on target (BP-OT) and BP not on target (BP-NOT). In total, 450 patients were included from August 2009 until January 2016. The mean age was 63 ± 9 years, and the majority was male (58%). In total, 53% had BP-OT. In those with BP-NOT, pharmacological management was suboptimal (zero to two antihypertensive drugs) in 62% of patients, and nutritional guideline adherence was suboptimal in 100% of patients (only 8% had a sodium intake on target, 66% had a potassium intake on target, 3% had a sodium-to-potassium ratio on target, and body mass index was <30 kg/m2 in 35%). These data show pharmacological undertreatment and a low adherence to nutritional guidelines. Uncontrolled BP is common in T2DM, and our data show a window of opportunity for improving BP control, especially in nutritional management. To improve treatment quality, we advocate to incorporate the integrated monitoring of nutritional management in quality improvement cycles in routine care.

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Overall quality of diabetes care in a defined geographic region: different sides of the same story

Cited by 18 publications

References 16 publications

Factors associated with treatment in primary versus specialist care: A population‐based study of people with type 2 and type 1 diabetes

Factors associated with treatment in primary versus specialist care: A population‐based study of people with type 2 and type 1 diabetes

Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey

Integrated Assessment of Pharmacological and Nutritional Cardiovascular Risk Management: Blood Pressure Control in the DIAbetes and LifEstyle Cohort Twente (DIALECT)

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