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Review paper

Quality of care for patients with diabetes done by family medicine team during the period 2013-2016

By
Larisa Gavran Orcid logo ,
Larisa Gavran
Contact Larisa Gavran

Family Medicine Teaching Centre, Primary Health Care Zenica , Zenica , Bosnia and Herzegovina

Salih Tandir ,
Salih Tandir

School of Medicine, University of Zenica , Zenica , Bosnia and Herzegovina

Suad Sivić ,
Suad Sivić

School of Medicine, University of Zenica , Zenica , Bosnia and Herzegovina

Institute for Health and Food Safety Zenica , Zenica , Bosnia and Herzegovina

Fatima Topčić
Fatima Topčić

Family Medicine Teaching Centre, Primary Health Care Zenica , Zenica , Bosnia and Herzegovina

Abstract

Aim
To assess whether the quality of diabetes care provided by a family medicine team changed over the course of four years and to identify potential gaps in our practice in order to improve it in the future.
Methods
An audit was carried out for randomly selected 120 medical records (MC) from the Diabetes Registry of patients with type 1 or 2 diabetes mellitus treated by one family medicine team for four consecutive years, from 2013 to 2016. We examined demographic data (gender, age, diabetes type, family history), annual examinations (glycated haemoglobin, blood glucose, lipid profile, neurological examination, urinalysis, foot care, ocular fundus and body mass index), prescribed insulin or other drugs and patients' education.
Results
Over the years females dominated with the maximum of 63% in 2013. In most years type 2 diabetes occurred in 93% of patients. The acceptable level of monitoring included examination of ocular fundus, lipid profile or total cholesterol, blood pressure, fasting and postprandial blood glucose with more than 80% annually. A low level of monitoring complications of diabetes was found on monofilament test, 26% in 2016, urinalysis, 20% in 2016 and examination of feet with the maximum of 46% in 2013. Outcome measurement showed satisfactory levels of glycated haemoglobin of 60% in 2014, blood pressure 76% in 2014, fast 56% and postprandial blood glucose of 73% in 2013.
Conclusion
We still need to find effective interventions that will lead to improvement of care for patients with diabetes in family medicine.

References

1
Agarwal G, Kaczorowski J, Hanna S. incentives for family medicine teams may contribute to improved services and better clinical outcomes. Canada Int J Family Med 2012:16–9.
2
Ohman-Strickland P, Orzano A, Hudson V, Solberg I, Di C-B, B, et al. Quality of diabetes care in family medicine practices: influence of nurse-practitioners and physician’s sssistants. Ann Fam Med 2008:14–22.
3
Gulliford M, Ashworth M, Robotham D, Mohiddin A. Achievement of metabolic targets for diabetes by English primary care practices under a new system of incentives. Diabet Med 2007:505–11.
4
Valk G, Renders C, Kriegsman D, Newton K, Twisk J, Eijk J, et al. Quality of care for patients with type 2 diabetes mellitus in the Netherlands and the United States: a comparison of two quality improvement programs. Health Serv Res 2004:709–25.
5
Lang B, V, Marković B, Kranjčević B, K. Family Physician clinical inertia in glycemic control among patients with type 2 diabetes. Med Sci Monit 2015:403–11.
6
Harris B. Clinical inertia in patients with T2DM requiring insulin in family practice. Can Fam Physician 2010:418–24.
7
Murphy M, Byrne M, Galvin R, Boland F, Fahey T, Smith S. Improving risk factor management for patients with poorly controlled type 2 diabetes: a systematic review of healthcare interventions in primary care and community settings. BMJ Open 2017.
8
Spann S, Nutting P, Galliher J, Peterson K, Pavlik V, Dickinson L, et al. Management of type 2 diabetes in the primary care setting: a practice-based research network study. Ann Fam Med 2006:23–31.
9
Riđanović Z, Kerleta-Tuzović V, Mellitus N. Standardi za timove porodične/obiteljske medicine. Sarajevo: Agencija za kvalitet i akreditaciju u zdravstvu u Federaciji Bosne i Hercegovine 2014:57–61.
10
Gavran L, Brkic S, Nuhbegovic S, Sivic S, Batic-Mujanovic O, Beganlic A. Improvement in monitoring of type 2 diabetes mellitus (DM) done by family medicine teams after implementation of DM flowcharts. Acta Inform Med 2009:15–9.
11
Compared with other studies, these results highlight that we need better understanding of possible reasons of such fluctuations in diabetes care over the years, as well as the reasons for the lack of causal relationship between the process of diabetes care and outcome of the measures (20) n.d.
12
World Health Organization: Definition, diagnosis and classification of diabetes mellitus and its complications. Part diagnosis and classification of diabetes mellitus. Geneva, Department of noncommunicable disease surveillance 1999.
13
Racic M, Kusmuk S, Mašić S, Ristić S, Ivković N, Djukanovic D, et al. Quality of diabetes care in family medicine practices in eastern Bosnia and Herzegovina. Prim Care Diabetes 2015:112–9.
14
Lee T, Chan S, Chua W, Harbinder K, Khoo Y, Yeang O, et al. Audit of diabetes mellitus in general practice. Med J Malaysia 2004:317–22.
15
Shehab A, Elnour A, Abdulle A. A clinical audit on diabetes care in patients with type 2 diabetes in Al-Ain, United Arab Emirates. Open Cardiovasc Med J 2012:126–32.
16
Rutten G. Care of patients with type 2 diabetes mellitus in primary care. Ned Tijdschr Geneeskd 2008:2389–94.
17
Novo A, Jokić I. Medical audit of diabetes mellitus in primary care setting in Bosnia and Herzegovina. Croat Med J 2008:757–62.
18
Renders C, Valk G, Griffin S, Wagner E, Van E, Assendelft J, et al. Interventions to improve the management of diabetes in primary care, outpatient and community settings: a systematic review. Diabetes Care 2001:1821–33.
19
Georgiou A, Burns J, Mckenzie S, Penn D, Flack J, Harris M. Monitoring ghange in diabetes care using diabetes registes. Experience from division of general practice. Aust Fam Physician 2006:77–80.
20
Zachariadou T, Makri L, Stoffers H, Philalithis A, Lionis C. The need for quality management in primary health care in Cyprus: results from a medical audit for patients with type 2 diabetes mellitus. Qual Manag Health Care 2006:58–65.
21
International Diabetes Federation. IDF diabetes atlas-7 20AD.

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