Continuous quality control in diabetes care – implications

Abstract

AbstractA prospective evaluation of randomly selected consultations was conducted to assess the quality of diabetes care with regard to metabolic control, education of patients, and patient satisfaction. Patients completed an anonymous questionnaire. Health professionals completed a separate questionnaire to record data, and to indicate whether medication was changed and if any education was given.All consultations were conducted by health professionals in secondary care, during six consecutive months. Patients responded to three statements, on a five‐point scale. The statements were: I feel better after this consultation; I was given enough time to discuss my problems; and I have learnt something new about diabetes at this consultation. Biomedical indicators were age, sex, type of therapy for diabetes, BMI, HbA1c, blood pressure and cholesterol.Out of a total of 2213 consultations, 721 (32.6%) were audited; 89% of consultations were conducted by career grade clinicians. There was a high degree of patient satisfaction. The number of patients who had HbA1c of 7% or less was 38 (14%) in the insulin group, and 150 (33%) in the tablet group. Mean (SD) cholesterol was 5.25 (1.03) and 5.4 (1.03) in the insulin and tablet groups respectively. Blood pressure readings were lower in the insulin group.In conclusion, the metabolic standards do not meet those currently recommended although there was a high degree of patient satisfaction. In order to be able to compare quality standards of this evaluation with those provided by other units, it is recommended that there is a national agreement on the cohort of patients in audit, the indicators to be used, and how each indicator is to be expressed. It is also necessary to establish a nationally agreed questionnaire, easy to administer in routine practice, to evaluate patient satisfaction and responses. Copyright © 2003 John Wiley & Sons, Ltd.