ISMENA GOWANIA, PORADNIA DIABETOLOGICZNA

COMPARISON OF DIABETES CARE QUALITY AND

OUTCOMES IN GENERAL PRACTICE AND SPECIALISTIC
CARE LETTER TO THE EDITOR
PORWNANIE JAKOCI OPIEKI DIABETOLOGICZNEJ W PODSTAWOWEJ
I SPECJALISTYCZNEJ OPIECE MEDYCZNEJ LIST DO REDAKCJI
LETTER TO THE MEDYCYNA METABOLICZNA
The quality of medical care delivered to diabetic patients at the general practice and the specialist levels is one
of the most practical problems in shaping their prognosis
Inappropriate diabetes mellitus care results in premature
development of late complications and increases the costs
of treatment
In our study these circumstances were delineated The
results should be of interest for basic care and specialist
medical care performers Therefore we would like to share
our results with Medycyna Metaboliczna readers
Aim of study: Assessment of the quality of the diabetological care at its different levels by multifactorial analysis
of selected laboratory and clinical parameters
Material and methods: Randomly selected diabetic patients from 18 medical ambulatory centers representing 3
levels of diabetological care: 1) general practice, 2) diabetes
mellitus basic and 3) diabetes mellitus highly specialistic
care were included into study Respective quality of care
indicators were collected with a questionnaires for patients
and physicians Data we analysed in the respect to organizational structure of care, its process and outcome measures
Results: The study included 1294 patients with diabetes
mellitus. Their average age was 60,6 14,5 years, average
diabetes mellitus duration was 12,1 8,6 years.
The HbAlC levels were measured in 29,9% of diabetic
patients at the general practice level, in 79,4% of diabetic
patients at the 2-nd degree diabetological care and in 91,4%
at the 3-rd degree, highly specialistic diabetological care
level (mostly connected with university hospitals)
The percentage of patients reaching the HbA1C level
below 6,5% were correspondingly at 3 care levels as
follows: 16,8, 25,0, and 27,5
Lipids levels were tested during 1 year before questioning in the following percentages of patients: general practice 42,9, first degree of specialist, diabetological care

41,7 and highly specialized 3-rd degree diabetological

care institutions 42,9%. The levels of total cholesterol,
HD and LDL cholesterol and triglycerides on respectively 3 levels of care reached the recommended criteria
as follows: 1,6%, 7,9% and 14,9%.
Microangiopathy complications were most frequent in
patients on the 2nd degree of specialist care, neuropathy
in persons treated on the lst degree of specialist care and
macroangiopathy was most frequent in general practice
Multiple logistic regression analysis showed, that likelihood of optimal care for patients on the lst degree specialist was about 14% lower in comparison with persons
treated on the 2nd level of the specialist care (p = 0,057)
and such chance for primary practice patients was about
95% lower (p < 0,001).
Conclusions: Considerable variation of the above described, selected parameters of the quality of care as achieved at 3 its levels point to the necessity for the systemic
accreditation and periodical quality control Monitoring the
quality of outcomes should become the routine method for
improving the outcomes of care in all its levels

Medycyna Metaboliczna, 2016, tom XX, nr 4

www.medycyna-metaboliczna.pl

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