Primary health care of diabetic patients in a specialized outpatient setting: a DIABCARE-based analysis.
To assure health care quality requires a tool for establishing the feedback between parameters of patient management and related standards. To assess the current situation and to evaluate the DIABCARE system as a potential monitoring instrument, a retrospective study was performed in 85 randomly assigned insulin-treated patients (72% type 2) who were regularly attending the diabetes outpatient unit (total of 3,595 patients) in a township of approximately 90,000 inhabitants. 1,195 records of sequential medical visits during the years 1987 and 1990 were analyzed. -Selected results (averages in 1987 vs. 1990): (1) Visits per year 6.9 vs 7.1; (2) intensified insulin treatment in 14 vs. 27% of all patients, they were on 4.0 vs. 4.5 injections per day applying doses of 0.8 vs. 0.6 IU kg-1 d-1; (3) glycaemic control: random blood glucose 6.0 vs. 5.8 mmol/l on conventional and 6.4 vs. 5.7 mmol/l on intensified regimes, HbA1 regular measurements in 2 vs. 21% of the patients; (4) body mass index 26.4 vs. 26.6 (conventional) and 24.7 vs. 25.9 (intensified) kg/(m)2; (5) retinopathy prevalence 30 vs. 29%, in 4 vs. 29% of the patients no information; (6) nephropathy prevalence 7 vs. 11%, in 75 vs. 68% of the patients no information; (7) foot complications prevalence 6 vs. 9%, in 91 vs. 84% of the patients no pathological findings. -The DIABCARE monitor proved appropriate but too laborious. The general level of care showed a tendency towards improvement between the two investigated periods but dit not yet meet the standards which must be attained to attain the St. Vincent Declaration.
Fischer
U
U
Gerhardt Katsch Institute of Diabetes Research, University of Greifswald, Karlsburg, Germany.
Salzsieder
E
E
Menzel
R
R
Vogt
L
L
Röpke
H
H
Schmidt
R
R
Heinke
P
P
D000328:Adult; D000368:Aged; D015992:Body Mass Index; D003153:Community Health Services; D003920:Diabetes Mellitus / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy; D003928:Diabetic Nephropathies / Q000453:epidemiology / Q000628:therapy; D003930:Diabetic Retinopathy / Q000453:epidemiology / Q000628:therapy; D005858:Germany; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D006973:Hypertension / Q000150:complications / Q000453:epidemiology; D008499:Medical Records; D008875:Middle Aged; D010348:Patient Care Team; D015995:Prevalence; D011320:Primary Health Care; D012189:Retrospective Studies
D006442:Glycated Hemoglobin