Quality of diabetes care in the Canadian forces.
BACKGROUND
Published data on quality of care indicators from various countries indicate the challenges of providing high-quality diabetes care. The objective of this study was to evaluate the quality of care provided to members of the Canadian Forces (CF) who have diabetes, by determining the extent to which healthcare providers adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines.


METHODS
All 14 CF bases meeting eligibility criteria were included in the evaluation. Cases of diabetes were ascertained based on laboratory criteria. Adherence to 21 CDA guideline recommendations was evaluated following a review of patient medical records.


RESULTS
The CF demonstrated high adherence (>75%) with 9 recommendations, moderate adherence (50% to 75%) with 7 recommendations and low adherence (<50%) with 5 recommendations. Most notably, there were 4 recommendations for which adherence was greater than 90%. The mean rate of adherence with all applicable recommendations per patient was 60.3% (95% Confidence Interval [CI], 59.0% to 61.6%). CF adherence rates were generally similar to or better than comparable rates in the civilian population within Canada and other industrialized countries.


CONCLUSIONS
It is unclear what accounts for the favourable quality of diabetes care in the CF Health Services, but this highly structured practice setting has a number of features that distinguish it from provincial healthcare systems. Several strategies can be considered to improve diabetes care even further, including providing feedback to physicians about their performance, promoting the use of diabetes care flow sheets and creating a diabetes registry.
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada. Electronic address: amolek@rogers.com.
Amole
A
Khadilkar
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Department of National Defence, Canadian Forces Health Services, Ottawa, Ontario, Canada.
Jeff
J
Whitehead
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Monica
M
Taljaard
Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada; Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
Doug
D
Manuel
D000328:Adult; D002170:Canada; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008889:Military Personnel; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care; D012189:Retrospective Studies
Canadian Forces; Clinical Practice Guidelines; Forces canadiennes; lignes directrices de pratique clinique; quality of care; qualité des soins