Quality of diabetes care in the community: a cross-sectional study in central Israel.
BACKGROUND
Good care of the diabetic patient reduces the incidence of long-term complications. Treatment should be interdisciplinary; in the last decade a debate has raged over how to optimize treatment and how to use the various services efficiently.


OBJECTIVE
To evaluate the quality of care of diabetic patients in primary care and diabetes clinics in the community in central Israel.


METHODS
We conducted a retrospective cross-sectional study of a random sample of 209 diabetic patients in a district of the largest health management organization in Israel. Patients were divided into two groups - those treated only by their family physician and those who had attended diabetes clinics. Data included social demographics, medications, risk factors, quality of follow-up, laboratory tests, quality of diabetes and blood pressure control, and complications of diabetes.


RESULTS
Of the 209 patients 38% were followed by a diabetes clinic and 62% by a family physician. Patients attending the specialist clinic tended to be younger (P= 0.01) and more educated (P= 0.017). The duration of their diabetes was longer (P < 0.01) and they had more diabetic microvascular complications (P= 0.001). The percentage of patients treated with insulin was higher among the diabetes clinic patients (75% vs. 14%, P= 0.0001). More patients with nephropathy received angiotensin-converting enzyme inhibitors in the diabetes clinic (94% vs. 68%, P= 0.02). Follow-up in the specialist clinic as compared to by the family physician was better in the areas of foot examination (P< 0.01), fundus examination (P= 0.0001), and hemoglobin A1c testing (P= 0.01). On a regression model only fundus examination, foot examination and documentation of smoking status were significantly better in the diabetes clinic (P< 0.05).


CONCLUSIONS
There is still a large gap between clinical guidelines and clinical practice. Joint treatment of diabetic patients between the family physician and the diabetes specialist may be a proposed model to improve follow-up and diabetes control. This model of treatment should be checked in a prospective study.
Vinker
Shlomo
S
Department of Family Medicine, Sackler Faculty of Medicine, Tel Aviv University, Ramat Aviv, Israel. vinker01@zahav.net.il
Nakar
Sasson
S
Ram
Ron
R
Lustman
Alex
A
Kitai
Eliezer
E
D000368:Aged; D000554:Ambulatory Care Facilities; D003430:Cross-Sectional Studies; D003920:Diabetes Mellitus / Q000145:classification / Q000188:drug therapy*; D004522:Educational Status; D005194:Family Practice; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007328:Insulin / Q000627:therapeutic use*; D007557:Israel; D008297:Male; D008875:Middle Aged; D011787:Quality of Health Care; D012189:Retrospective Studies; D012720:Severity of Illness Index
D007004:Hypoglycemic Agents; D007328:Insulin