Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: A population‐based retrospective cohort study after implementation of a quality improvement initiative

Wong, Carlos King Ho; Fung, Colman Siu Cheung; Yu, Esther Yee Tak; Wan, Eric Yuk Fai; Chan, Anca Ka Chun; Lam, Cindy Lo Kuen

doi:10.1002/dmrr.2952

Cited by 6 publications

(5 citation statements)

References 38 publications

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“…Another study from Italy employed a continuous Q -score to evaluate the quality of healthcare ( 23 ). Although we cannot compare our results directly to these studies, we note that two studies from China and Switzerland, using different indicators for quality of care, found overall low quality in the case management process of T2D, which is consistent with our results ( 24 , 25 ). In addition, using SPs in this study allowed us to record all patient-provider interactions as well as to observe real diagnostic questions asked by providers.…”

Section: Discussionsupporting

confidence: 90%

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China

Ye²,

Sun³

et al. 2022

Front. Public Health

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BackgroundImproving type 2 diabetes (T2D) care is key to managing and reducing disease burden due to the growing prevalence of diabetes worldwide, but research on this topic, specifically from rural areas, is limited. This study uses standardized patients (SPs) to assess T2D care quality among primary care providers to access the healthcare system in rural China.MethodsUsing multi-stage random sampling, health facilities, providers, and households were selected. SPs were used to evaluate providers' T2D care quality and a questionnaire survey was used to collect patient sorting behaviors from households. Logistic regression was used to explore factors correlated with T2D care quality. Provider referral and treatment rates were combined with patient sorting behaviors to assess the overall quality of T2D management by rural China's healthcare system.ResultsA total of 126 providers, 106 facilities, and 750 households were enrolled into this study. During SP interactions, 20% of rural providers followed the national guidelines for T2D consultation, 32.5% gave correct treatment, and 54.7% provided lifestyle suggestions. Multi-variable regression results showed that providers who had earned practicing certificates (β = 1.56, 95% CI: 0.44, 2.69) and saw more patients (β = 0.77, 95%: 0.25, 1.28) were more likely to use a higher number of recommended questions and perform better examinations, whereas providers who participated in online training were less likely to practice these behaviors (β = −1.03, 95%: −1.95, −0.11). The number of recommended questions and examination (NRQE) was the only significant correlated factor with correct treatment (marginal effect = 0.05, 95%: 0.01, 0.08). Throughout the rural healthcare system, 23.7% of T2D patients were treated correctly.ConclusionThe quality of T2D care in rural western China, especially throughout the consultation and treatment process during a patient's first visit, is poor. Online training may not improve T2D care quality and low patient volume was likely to indicate poor care quality. Further research is needed to explore interventions for improving T2D care quality in rural China's healthcare system.

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Section: Discussionsupporting

confidence: 90%

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China

Ye²,

Sun³

et al. 2022

Front. Public Health

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“…Another study in Hong Kong confirmed the finding of a sharp declining LDL-C trend in the early period (from 2010 to 2012) in our study, where mean LDL-C in patients with T2DM declined from 3.0 mmol/L in 2010 to 2.6 mmol/L in 2012. 33 The better control of LDL-C could have resulted from the increasing use of lipid-lowering drugs in Hong Kong, evident from an increase of 163.5%–188.7% in the proportion of patients using lipid-lowering agents (from 24.8% to 71.6% for males; from 28.2% to 74.3% for females) in 2019 among patients with T2DM ( Table 1 ). A previous study also reported that the prescription prevalence of statins had over 4-fold increase from 1.82% in 2004 to 8.68% in 2015, and the statins initiation rate increased from 0.44% in 2004 to 1.23% in 2013 in Hong Kong, and attributed such changes to the Hong Kong primary care reference frameworks for lipid management in patients with diabetes, which recommend initiating statin therapy with low- or moderate-intensity statins based on the patient's cardiovascular risk.…”

Section: Discussionmentioning

confidence: 99%

Trends of clinical parameters and incidences of diabetes mellitus complications among patients with type 2 diabetes mellitus in Hong Kong, 2010–2019: a retrospective cohort study

Wang

Mak

et al. 2023

eClinicalMedicine

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“…Studies identifying healthcare factors that predict the performance of screening for microvascular complications in diabetes care are scarce. Such studies usually assess quality improvement strategies, the introduction of incentives, feedback to GPs or involvement of ancillary staff . Our objectives were to identify person, GP and practice characteristics that are associated with the performance of screening procedures for microvascular complications in routine clinical practice, and if possible propose strategies that may improve Type 2 diabetes care.…”

Section: Introductionmentioning

confidence: 99%

Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway

et al. 2018

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Aims To assess population, general practitioner (GP) and practice characteristics associated with the performance of microvascular screening procedures and to propose strategies to improve Type 2 diabetes care. Methods A cross‐sectional survey in Norway (281 GPs from 77 practices) identified 8246 people with a Type 2 diabetes duration of 1 year or more. We used multilevel regression models with either the recording of at least two of three recommended screening procedures (albuminuria, monofilament, eye examination) or each procedure separately as dependent variable (yes/no), and characteristics related to the person with diabetes, GP or practice as independent variables. Results The performance of recommended screening procedures was recorded in the following percentages: albuminuria 31.5%, monofilament 27.5% and eye examination 60.0%. There was substantial heterogeneity between practices, and between GPs within practices for all procedures. Compared with people aged 60–69 years, those aged < 50 years were less likely to have an albuminuria test performed [odds ratio (OR) 0.75, 95% CI 0.61 to 0.93] and eye examination (OR 0.79, 95% CI 0.66 to 0.95). People with macrovascular disease had fewer screening procedures recorded (OR 0.68, 95% CI 0.59 to 0.78). Use of an electronic diabetes form was associated with improved screening (OR 2.65, 95% CI 1.86 to 3.78). GPs with high workload recorded fewer procedures (OR 0.59, 95% CI 0.39 to 0.90). Conclusions Performance of screening procedures was suboptimal overall, and in people who should be prioritized. Performance varied substantially between GPs and practices. The use of a structured diabetes form should be mandatory.

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Temporal trends in quality of primary care for patients with type 2 diabetes mellitus: A population‐based retrospective cohort study after implementation of a quality improvement initiative

Abstract: Coinciding with implementation of quality improvement initiative, quality of diabetes care improved significantly in the past 5 years, in part attributable to benefits of integrated multidisciplinary diabetes management.

Cited by 6 publications

References 38 publications

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China

Using standardized patients to assess the quality of type 2 diabetes care among primary care providers and the health system: Evidence from rural areas of western China

Trends of clinical parameters and incidences of diabetes mellitus complications among patients with type 2 diabetes mellitus in Hong Kong, 2010–2019: a retrospective cohort study

Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway

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