Multistrategic approach to improve quality of care of people with diabetes at the primary care level: study design and baseline data

Abstract

To testthe one year-post effect of an integrated diabetes care program thatincludes systemchanges, education, registry (clinical, metabolic and therapeutic indicators) and diseasemanagement (DIAPREM), implemented at primary care level, on care outcomes and costs.Methods: We randomly selected 15 physicians and 15 nurses from primary care units ofLa Matanza County to be trained (Intervention-IG) and another 15 physicians/nurses touse as controls (Control-CG). Each physician-nurse team controlled and followed up 10patients 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.Results: 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.