Effectiveness of a structured diabetes care program with limited resources

Abstract

| 311 limited economic resources in Mexico. Patients and methods: A prospective study was conducted in diabetes patients treated at outpatient diabetes clinics established in 2001-2007 as the state diabetes program in Hidalgo Mexico, one of the poorest states in the country, with a mostly rural population. Baseline and follow-up consultation was provided by multidisciplinary teams including general physicians and nurses as a minimum. Goals of treatment were clearly explained and negotiated with each patient. Organizational arrangements were made to reduce waiting times, avoid rotation of doctors and nurses, and provide adequate time for baseline and follow-up visits. Each follow-up visit included measuring process and outcomes indicators of quality of diabetes care, including: 1) body mass index; 2) blood pressure; 3) fasting or casual blood glucose 4) lipoprotein measurement; 5) hemoglobin A1c (HbA1c); and 6) foot examination. results: Analysis of 4,393 patients who attended five visits showed the following increases in the percent of recorded process indicators of quality of diabetes care from baseline: 1) body mass index, 85.0 vs. 95.9%; 2) blood pressure measurement, 73.29 vs. 95.6%; 3) HbA1c 12.5 vs. 17.7%; 4) total cholesterol, 18.2 vs. 55.9%; 5); 6) foot examination, 19.0 vs. 95.0%. Outcome measures that showed non-statistically significant differences were body mass index (27.79±4.9 vs. 27.82±4.76), systolic blood pressure (124.7±21.36 vs. 123.54±19.27 mmHg), total cholesterol (193.50±47.94 vs. 208.41±54.02 mg/dl) and triglycerides (258.2±231.5 vs. 244.7±181.6 mg/dl). Significant improvements in glycemic control were documented by a decrease in fasting blood glucose (185.75±79.01 vs. 162.89±72.53 mg/dl, P <0.001), and a 3.6 percentage point decrease in HbA1c (12.05%±4.47 vs. 8.45±1.89, P 0.001). conclusions: The results confirm that it is possible to improve the quality of diabetes care at the primary care level without additional economic resources, through the implementation of a program that integrates changes in the structure and in the process of care, customized clinical guidelines, and a standardized system of information that enables measuring clinical results in settings with limited resources. Models of care delivery No conflict of interest