title: Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India.
abstract: OBJECTIVE
  To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India.
  
  
  METHODS
  We interviewed physicians (n = 23) and patients with diabetes (n = 406), and reviewed patient charts at general practices (government = 5; private = 18). We examined diabetes care processes, specifically measurement of weight, blood pressure (BP), glycated hemoglobin (HbA1c), lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model.
  
  
  RESULTS
  The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7), and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model.
  
  
  CONCLUSIONS
  Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.
authors.affiliation: Centre of Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: Roopa
authors.initials: R
authors.lastname: Shivashankar
authors.affiliation: Centre of Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: Sandeep
authors.initials: S
authors.lastname: Bhalla
authors.affiliation: Centre of Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: Dimple
authors.initials: D
authors.lastname: Kondal
authors.affiliation: Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: Mohammed K
authors.initials: MK
authors.lastname: Ali
authors.affiliation: Centre of Chronic Conditions and Injuries, Public Health Foundation of India, New Delhi, India; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: Dorairaj
authors.initials: D
authors.lastname: Prabhakaran
authors.affiliation: Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: K M Venkat
authors.initials: KM
authors.lastname: Narayan
authors.affiliation: Department of Endocrinology and Metabolism, All India Institute of Medical Sciences, New Delhi, India; Centre for Control of Chronic Conditions(4C), New Delhi, India.
authors.forename: Nikhil
authors.initials: N
authors.lastname: Tandon
keywords: Diabetes; India; primary care; quality of care