Fifteen years of continuous improvement of quality care of type 2 diabetes mellitus in primary care in Catalonia, Spain

Abstract

AimsTo assess the evolution of type 2 diabetes mellitus (T2DM) quality indicators in primary care centers (PCC) as part of the Group for the Study of Diabetes in Primary Care (GEDAPS) Continuous Quality Improvement (GCQI) programme in Catalonia.MethodsSequential cross-sectional studies were performed during 1993–2007. Process and outcome indicators in random samples of patients from each centre were collected. The results of each evaluation were returned to each centre to encourage the implementation of correcting interventions. Sixty-four different educational activities were performed during the study period with the participation of 2041 professionals.ResultsClinical records of 23,501 patients were evaluated. A significant improvement was observed in the determination of some annual process indicators: HbA1c (51.7% vs. 88.9%); total cholesterol (75.9% vs. 90.9%); albuminuria screening (33.9% vs. 59.4%) and foot examination (48.9% vs. 64.2%). The intermediate outcome indicators also showed significant improvements: glycemic control [HbA1c ≤ 7% (< 57 mmol/mol); (41.5% vs. 64.2%)]; total cholesterol [≤ 200 mg/dl (5.17 mmol/l); (25.5% vs. 65.6%)]; blood pressure [≤ 140/90 mmHg; (45.4% vs. 66.1%)]. In addition, a significant improvement in some final outcome indicators such as prevalence of foot ulcers (7.6% vs. 2.6%); amputations (1.9% vs. 0.6%) and retinopathy (18.8% vs. 8.6%) was observed.ConclusionsAlthough those changes should not be strictly attributed to the GCQI programme, significant improvements in some process indicators, parameters of control and complications were observed in a network of primary care centres in Catalonia.

The impact of a programme to improve quality of care for people with type 2 diabetes on hard to reach groups: The GEDAPS study

“…GEDAPS is described in detail elsewhere [5,6]. Briefly, GEDAPS was implemented in Catalonia, where there is a public health system, 70% of the population live in urban areas, and the prevalence of diabetes was approximately 4.7% when the programme began [5].…”

“…Generally, such programmes have been shown to impact positively on patients' care and health [2][3][4], including the GEDAPS programme (Group of Study of Diabetes in Primary Care) which was implemented in primary care in Catalonia, Spain between 1993 and 2002 [5,6]. GEDAPS resulted in improvements in process, intermediate and final outcomes when the patient population was considered as a whole [5,6]. It is however unclear whether quality improvement programmes, including GEDAPS, impact positively on all populations or whether a different approach is required for some hard to reach groups.…”

“…GEDAPS was a continuous quality improvement programme with a multifactorial approach, and its main aim was to implement the St Vincent recommendations [7]. The programme was shown to improve intermediate and long term outcomes for patients with T2DM [5,6], and has been partly adopted by the national health service in Spain [8].…”

Knowledge and Practice of Foot Care in Diabetic Inpatients: A Descriptive Cross-Sectional Study

“…Attributes of health professionals regarding providing information about diabetes are among the factors that may be effective in reducing DFU (6). The aim of DFU prevention should be to teach self-foot care to patients and to examine their foot at each reconsultation.…”

Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations

“…In Spain, for example, primary care centres, which are similar to those participating in the present study, demonstrated significant improvements between 1993 and 2007 in process measures (such as measurement of HbA1c and lipid levels), intermediate outcome measures [including the proportion of patients with HbA1c ≤7.0% (53 mmol/mol), total cholesterol ≤ 200 mg/dl and blood pressure ≤ 140/90 mmHg], and microvascular complications 27, 28. Primary care–led structured care, with relatively limited but well‐focussed investment, can achieve quality of care for patients with diabetes, comparable to international best practice 7.…”