title: Multistrategic approach to improve quality of care of people with diabetes at the primary care level: Study design and baseline data.
abstract: To test the one year-post effect of an integrated diabetes care program that includes system changes, education, registry (clinical, metabolic and therapeutic indicators) and disease management (DIAPREM), implemented at primary care level, on care outcomes and costs.
  
  
  
  We randomly selected 15 physicians and 15 nurses from primary care units of La Matanza County to be trained (Intervention-IG) and another 15 physicians/nurses to use as controls (Control-CG). Each physician-nurse team controlled and followed up 10 patients with type 2 diabetes for one year; both groups use structured medical data registry. Patients in IG had quarterly clinical appointments whereas those in CG received traditional care. DIAPREM includes system changes (use of guidelines, programmed quarterly controls and yearly visits to the specialist) and education (physicians' and nurses' training courses). Statistical data analysis included parametric/nonparametric tests according to data distribution profile and Chi-squared test for proportions.
  
  
  
  Baseline data from both groups showed comparable values and 20-30% of them did not perform HbA1c and lipid profile measurements. Majority were obese, 59% had HbA1C ≥7%, 86% fasting blood glucose ≥100mg/dL, 45%, total cholesterol ≥200mg/dL, and 92% abnormal HDL- and LDL-cholesterol values. Similarly, micro and macroangiopathic complications had not been detected in the previous year. Most patients received oral antidiabetic agents (monotherapy), and one third was on insulin (mostly a single dose of an intermediate/long-acting formulation). Most people with hypertension received specific drug treatment but only half of them reached target values; dyslipidemia treatment showed similar data.
  
  
  
  Baseline data demonstrated the need of implementing an intervention to improve diabetes care and treatment outcomes.
authors.affiliation: CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET) La Plata, Facultad de Ciencias Médicas UNLP, La Plata, Argentina.
authors.forename: Mariana
authors.initials: M
authors.lastname: Prestes
authors.affiliation: Coordinadora del PRODIABA, Secretaría de Salud, Municipalidad de La Matanza, Argentina.
authors.forename: María Angelica
authors.initials: MA
authors.lastname: Gayarre
authors.affiliation: CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET) La Plata, Facultad de Ciencias Médicas UNLP, La Plata, Argentina.
authors.forename: Jorge Federico
authors.initials: JF
authors.lastname: Elgart
authors.affiliation: CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET) La Plata, Facultad de Ciencias Médicas UNLP, La Plata, Argentina; Escuela de Economía de la Salud y Administración de Organizaciones de Salud, Facultad de Ciencias Económicas, UNLP, La Plata, Argentina.
authors.forename: Lorena
authors.initials: L
authors.lastname: Gonzalez
authors.affiliation: CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET) La Plata, Facultad de Ciencias Médicas UNLP, La Plata, Argentina; III-LIDI, Facultad de Informática, Universidad Nacional de La Plata, La Plata, Argentina.
authors.forename: Enzo
authors.initials: E
authors.lastname: Rucci
authors.affiliation: CENEXA-Centro de Endocrinología Experimental y Aplicada (UNLP-CONICET) La Plata, Facultad de Ciencias Médicas UNLP, La Plata, Argentina. Electronic address: cenexaar@yahoo.com.ar.
authors.forename: Juan José
authors.initials: JJ
authors.lastname: Gagliardino
mesh_terms: D000328:Adult; D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D001118:Argentina / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D016009:Chi-Square Distribution; D002985:Clinical Protocols; D015897:Comorbidity; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D050171:Dyslipidemias / Q000188:drug therapy / Q000453:epidemiology; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000188:drug therapy / Q000453:epidemiology; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000453:epidemiology / Q000628:therapy; D010348:Patient Care Team / Q000458:organization & administration*; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration*; D017064:Process Assessment, Health Care / Q000458:organization & administration*; D058996:Quality Improvement / Q000458:organization & administration*; D019984:Quality Indicators, Health Care / Q000458:organization & administration*; D012042:Registries; D012107:Research Design; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D000959:Antihypertensive Agents; D015415:Biomarkers; D001786:Blood Glucose; D006442:Glycated Hemoglobin; D000960:Hypolipidemic Agents; C517652:hemoglobin A1c protein, human
keywords: Diabetes primary care; Disease management; Medical data registry; Quality of care; Therapeutic education; Treatment adherence