title: [CroDiab web and improvement of diabetes care at the primary health care level].
abstract: OBJECTIVE
  Diabetes is a complex metabolic disorder regarded as one of the most significant public health issues of the 21S century. Keeping a diabetes registry facilitates monitoring of the epidemiological situation, while a structured approach to the registration of diabetic patients (reporting on an optimum information cluster for the follow-up and improvement of diabetes care) contributes to better regulation of patient risk factors. Active patient reporting at the primary health care level has begun in 2006 with setting up the legislative background. The aim of this study was to establish the effect of the CroDiab registry on metabolic parameters in type 2 diabetic patients treated at primary health care level by comparing diabetes indicators between the regularly annually reported type 2 diabetic patients and those that were only intermittently reported to the registry from 2006 until 2008.
  
  
  METHODS
  Family physicians submit their reports mainly via CroDiab web, a Croatian web-based system for the collection of data on diabetic patients, which enables analysis of the basic clinical and public health indices. The levels of fasting and postprandial blood glucose, HbA1c, triglycerides, total cholesterol, HDL- and LDL-cholesterol, systolic and diastolic blood pressure, and body mass index were analyzed in 2006 and 2008, and compared between the two study groups.
  
  
  RESULTS
  At baseline, differences between the intermittently reported (I) and regularly reported (R) groups were only observed in the systolic (I 142.4+/-16.6, R 136.8+/-16.6 mm Hg; p<0.001) and diastolic (1 83.9+/-8.2, R 82.1+/-10.0 mm Hg; P=0.002) blood pressure, while at the end of the study period differences were also recorded in postprandial blood glucose (I 10.63+3.12, R 10.02+/-3.44 mmol/L; P=0.024), HbA1c (I 7.97+/-1.52, R 7.39+/-1.17%; P<0.001), total cholesterol (I 5.60+/-1.15, R 5.25+/-1.13 mmol/L; p<0.001) and LDL-cholesterol (I 3.28+/-0.93, R 2.98+/-0.92 mmol/L; P<0.001). There were no statistically significant differences in body mass index, fasting glucose, HDL-cholesterol and triglycerides.
  
  
  CONCLUSIONS
  Electronic medical records and structured health care are associated with increased benefits and improvement in metabolic indicators at the primary health care level. Regular reporting and monitoring via CroDiab registry lead to a significant improvement in the majority of metabolic indicators, which is less marked with intermittent reporting. The more pronounced effect observed in the group of patients that were regularly covered by the registry could be attributed to a more comprehensive and regular insight and better patient care associated with continuous monitoring. Further efforts are therefore needed to achieve the widest possible implementation of the CroDiab web system to improve diabetes care at the primary health care level.
authors.affiliation: Vuk Vrhovac University Clinic, Merkur University Hospital, Zagreb, Croatia. tamara.poljicanin@idb.hr
authors.forename: Tamara
authors.initials: T
authors.lastname: Poljicanin
authors.forename: Mario
authors.initials: M
authors.lastname: Sekerija
authors.forename: Zeljko
authors.initials: Z
authors.lastname: Metelko
mesh_terms: D017523:Croatia; D003920:Diabetes Mellitus / Q000628:therapy*; D006801:Humans; D008875:Middle Aged; D011320:Primary Health Care; D058996:Quality Improvement; D012042:Registries