title: Health care delivery in type 2 diabetes. A survey in an Italian primary care practice.
abstract: OBJECTIVE
  Evidence-based guidelines provide targets and performance measures for the treatment of type 2 diabetic patients but a wide gap separates guidelines-driven recommendations from their clinical application, a phenomenon hindering the transfer of proven benefits to affected populations.
  
  
  METHODS
  We analyzed the quality of diabetic care delivered by 8 general practitioners joint in a group practice attending 571 diabetic patients (5.6% of the total enlisted subjects) by assessing process (% of HbA1c, SBP and LDL-C determinations) and intermediate outcome (% of patients with HbA1c <7% vs >8%, systolic BP <130 mmHg vs >140 mmHg, LDL-cholesterol <100 mg/dL vs >130 mg/dL) indicators.
  
  
  RESULTS
  HbA1c was at target in 49% of patients and >8% in 22%; SBP and LDL-C determination was available in about two-thirds of patients, only a minority at target for SBP and LDL-C. Antihyperglycemic and antihypertensive treatment was prescribed in most patients but only a third was on statins. During the post-evaluation phase, percentages of patients with HbA1c >8%, SBP < 130 mmHg and LDL-C < 100 mg/dL and the drug prescription pattern did not change.
  
  
  CONCLUSIONS
  Several weaknesses affect primary care delivery to type 2 diabetic patients and efforts are needed to improve the management of this high-risk group.
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Modesti
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Bartaloni
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Franca
authors.initials: F
authors.lastname: Bellagamba
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Rossano
authors.initials: R
authors.lastname: Caglieri
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Katia
authors.initials: K
authors.lastname: Cenori
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Giorgio
authors.initials: G
authors.lastname: Ciampalini
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Attilio
authors.initials: A
authors.lastname: Costagli
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Vanni
authors.initials: V
authors.lastname: Galloni
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Del Papa
authors.affiliation: "Modulo Pontedera" Progetto Regionale di Medicina d'Iniziativa, Pontedera, Italy.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Modesti
authors.affiliation: Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Italy.
authors.forename: Giulia
authors.initials: G
authors.lastname: Dell'Omo
authors.affiliation: Dipartimento di Patologia Chirurgica, Medica, Molecolare e dell'Area Critica, Università di Pisa, Italy. Electronic address: r.pedrinelli@med.unipi.it.
authors.forename: Roberto
authors.initials: R
authors.lastname: Pedrinelli
mesh_terms: D000959:Antihypertensive Agents / Q000627:therapeutic use*; D015415:Biomarkers / Q000097:blood; D001794:Blood Pressure / Q000187:drug effects; D008078:Cholesterol, LDL / Q000097:blood; D003695:Delivery of Health Care / Q000458:organization & administration / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D019983:Guideline Adherence; D019538:Health Care Surveys; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007558:Italy; D008297:Male; D008875:Middle Aged; D017146:Models, Organizational; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000592:standards; D011320:Primary Health Care / Q000458:organization & administration / Q000592:standards; D017064:Process Assessment, Health Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D008078:Cholesterol, LDL; D006442:Glycated Hemoglobin; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D007004:Hypoglycemic Agents; C517652:hemoglobin A1c protein, human
keywords: Health services; Outcomes research; Primary care; Type 2 diabetes