Evaluation of the impact of the Kuwait Diabetes Care Program on the quality of diabetes care.
OBJECTIVE
To evaluate the impact of the Kuwait Diabetes Care Program on the quality of care provided for diabetic patients in the Primary Health Care setting.


METHODS
The Kuwait Diabetes Care Program developed, published and disseminated clinical practice guidelines, conducted training courses, standards for diabetes care, and introduced a monitoring and evaluation system. Four audits (September 1999, October 2001, 2002 and 2003) were carried out at five diabetic clinics. September 1999 referred to in this study as first (baseline) audit was prior to the introduction of the clinical practice guidelines. The three other audits were performed to assess adherence with the guidelines in the administrative management of patients' records and implementation of the standards. Two hundred and fifty patients were involved in the study.


RESULTS
The proportion of patients with organized, structured files increased significantly from 60.0 to 100.0% (p < 0.001), and recording of patients' demographic data increased from 38.6 to 95.6% (p < 0.001). Use of structured visit sheets, proper fixation of the laboratory and prescription sheets had also improved significantly. The prevalence of smoking assessment, fundus examination, and foot examination increased significantly from 2.8 to 27.2% (p < 0.001); 2.4 to 31.6% (p < 0.001); 0.4 to 40.4% (p < 0.001), respectively. The prevalence of measuring urinary microalbumin, serum creatinine and HbA(1c) increased significantly from 4.4 to 26.4% (p < 0.001); 16.0 to 78.4% (p < 0.001), and 10.4 to 60.8% (p < 0.001), respectively. The prevalence of measuring serum total cholesterol, triglycerides, HDL-C, and LDL-C levels increased significantly from 16.4 to 80.0% (p < 0.001); 14.4 to 80.0% (p < 0.001); 2.4 to 32.8% (p < 0.001), and 2.4 to 24.0% (p < 0.001), respectively.


CONCLUSIONS
This audit shows that a national diabetes program was associated with improved processes of diabetes care. Further, support from health authorities, provision of manpower resources, a continuing monitoring and evaluation system, and conduction of structured education programs may lead to further improvements in the quality of diabetes care.
Working Group of the Diabetes Care Program, Central Department of Primary Health Care, Ministry of Health, Al-Sabah Hospital, Kuwait. amsaladsani@yahoo.com
Afaf
A
Al-Adsani
Jamila
J
Al-Faraj
Fatma
F
Al-Sultan
Mohamed
M
El-Feky
Nouria
N
Al-Mezel
Wafik
W
Saba
Sharifa
S
Aljassar
D000554:Ambulatory Care Facilities; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000628:therapy*; D004282:Documentation / Q000706:statistics & numerical data; D019983:Guideline Adherence / Q000706:statistics & numerical data; D006801:Humans; D007730:Kuwait; D008330:Management Audit; D008485:Medical Audit; D009313:National Health Programs / Q000458:organization & administration*; D017410:Practice Guidelines as Topic; D015397:Program Evaluation; D011785:Quality Assurance, Health Care; D000078329:Workforce