title: Need and disparities in primary care management of patients with diabetes.
abstract: BACKGROUND
  An aging population means that chronic illnesses, such as diabetes, are becoming more prevalent and demands for care are rising. Members of primary care teams should organize and coordinate patient care with a view to improving quality of care and impartial adherence to evidence-based practices for all patients. The aims of the present study were: to ascertain the prevalence of diabetes in an Italian population, stratified by age, gender and citizenship; and to identify the rate of compliance with recommended guidelines for monitoring diabetes, to see whether disparities exist in the quality of diabetes patient management.
  
  
  METHODS
  A population-based analysis was performed on a dataset obtained by processing public health administration databases. The presence of diabetes and compliance with standards of care were estimated using appropriate algorithms. A multilevel logistic regression analysis was applied to assess factors affecting compliance with standards of care.
  
  
  RESULTS
  1,948,622 Italians aged 16+ were included in the study. In this population, 105,987 subjects were identified as having diabetes on January 1st, 2009. The prevalence of diabetes was 5.43% (95% CI 5.33-5.54) overall, 5.87% (95% CI 5.82-5.92) among males, and 5.05% (95% CI 5.00-5.09) among females. HbA1c levels had been tested in 60.50% of our diabetic subjects, LDL cholesterol levels in 57.50%, and creatinine levels in 63.27%, but only 44.19% of the diabetic individuals had undergone a comprehensive assessment during one year of care. Statistical differences in diabetes care management emerged relating to gender, age, diagnostic latency period, comorbidity and citizenship.
  
  
  CONCLUSIONS
  Process management indicators need to be used not only for the overall assessment of health care processes, but also to monitor disparities in the provision of health care.
authors.affiliation: Department of Molecular Medicine of the University of Padova, Laboratory of Public Health and Population Studies, Via Loredan, 18, 35100 Padova, Italy. alessandra.buja@unipd.it.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Buja
authors.forename: Rosa
authors.initials: R
authors.lastname: Gini
authors.forename: Modesta
authors.initials: M
authors.lastname: Visca
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Damiani
authors.forename: Bruno
authors.initials: B
authors.lastname: Federico
authors.forename: Daniele
authors.initials: D
authors.lastname: Donato
authors.forename: Paolo
authors.initials: P
authors.lastname: Francesconi
authors.forename: Alessandro
authors.initials: A
authors.lastname: Marini
authors.forename: Andrea
authors.initials: A
authors.lastname: Donatini
authors.forename: Salvatore
authors.initials: S
authors.lastname: Brugaletta
authors.forename: Giorgia
authors.initials: G
authors.lastname: Bardelle
authors.forename: Vincenzo
authors.initials: V
authors.lastname: Baldo
authors.forename: Mariadonata
authors.initials: M
authors.lastname: Bellentani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D066264:Datasets as Topic; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D019468:Disease Management; D005260:Female; D005500:Follow-Up Studies; D006301:Health Services Needs and Demand; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010349:Patient Compliance; D011320:Primary Health Care / Q000592:standards*; D011379:Prognosis; D019984:Quality Indicators, Health Care / Q000592:standards*; D018570:Risk Assessment; D055815:Young Adult