The relationship between primary health care organization and quality of diabetes care.
BACKGROUND
Despite many quality improvement trials, diabetes care often remains suboptimal. Few studies in a primary care setting have investigated the 'real life' association between organizational differences and quality of diabetes care.


METHODS
Observational study among ten health care centres with a total of 45 general practitioners (GP). We investigated health care organization and related this to quality of care in a total of 1849 electronic patient records.


RESULTS
There were large differences among health care centres in the percentage of patients receiving optimal care (range: 8-67%). The odds to receive good quality of care was higher if the health care centre had a diabetes education program (OR: 4.3; CI: 3.4-5.4), when yearly medical check-ups were done by both the GP and nurse practitioner (NP) (OR: 5.5; CI: 4.2-7.3), planned that after the patient visited the NP the patient is discussed with the GP (OR: 1.8; CI: 1.6-2.0), and had structured follow-up measures for compliance to check-ups (OR: 0.7; CI: 0.5-0.9 and OR: 0.59; CI: 0.5-0.7 for respectively one and two active measures compared to three active measures).


CONCLUSIONS
Also in real life, quality of care for type 2 diabetic patients is related to health care organization.
Spigt
Mark
M
Maastricht University, Department of General Practice, School for Public Health and Primary Care (CAPHRI), Maastricht, The Netherlands. m.spigt@hag.unimaas.nl
Stefens
Caroline
C
Passage
Danique
D
Van Amelsvoort
Ludovic
L
Zwietering
Paul
P
D000368:Aged; D003625:Data Collection; D003924:Diabetes Mellitus, Type 2 / Q000628:therapy*; D057286:Electronic Health Records; D005194:Family Practice / Q000458:organization & administration* / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D009722:Nurse Practitioners / Q000458:organization & administration; D010353:Patient Education as Topic / Q000379:methods; D010821:Physicians, Family / Q000458:organization & administration; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D011787:Quality of Health Care / Q000458:organization & administration*