[Care of patients with type 2 diabetes mellitus in primary care].
Over the past 20 years, delivery ofdiabetes care in the Netherlands has shifted from secondary to primary care. Currently over 75% of all patients with type 2 diabetes mellitus are being treated by a diabetes team in general practice. Since 2000 both national and international publications have been describing the organisation and quality of primary diabetes care in the Netherlands. Apart from 4 large-scale diabetes projects in the areas of Zwolle, Hoorn, Maastricht and Breda, primary diabetes care is organised in various ways. At the end of 2005 a questionnaire sent to a representative group of 1621 general practitioners revealed that 95% kept a computerised diabetes register, one out of three practices delegated tasks to a diabetes service, and 20% of the practices had a shared care protocol with specialists. 2 out of 3 practices ran a diabetes clinic in which 2 out of 3 a practice nurse was involved. The results of 9 projects are known. 3 projects concern cross-sectional findings of disease management organisations, 6 concern general practices which were not participating in a diabetes project at the time of measurement, and 2 are clinical trials. Most of these measurements yielded representative data. They show that mean HbA(1C) levels < 7%, mean systolic blood pressure of about 143 mmHg, and mean cholesterol levels of about 4.5 mmol/l are achievable. With logistic support, regular check-ups of fundus and feet are achieved in 9 out of 10 patients. No special organisational model has proved to be superior. A correct assessment of quality of care indicators should take into account the heterogeneity of type 2 diabetes mellitus, as well as the socio-economic status and the ethnicity of the patient population.
Rutten
G E H M
GE
Universitair Medisch Centrum Utrecht, divisie Julius Centrum voor Gezondheidswetenschappen en Eerstelijnsgeneeskunde, afd. Huisartsgeneeskunde, Postbus 85.500, 3508 GA Utrecht. g.e.h.m.rutten@umcutrecht.nl
D003695:Delivery of Health Care / Q000379:methods* / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D005006:Ethnicity; D006801:Humans; D009426:Netherlands; D010818:Practice Patterns, Physicians' / Q000592:standards; D011320:Primary Health Care / Q000379:methods / Q000592:standards*; D011787:Quality of Health Care; D012959:Socioeconomic Factors