Quality indicators in type 2 diabetes patient care: analysis per care-complexity level

Josiane Schneiders,Bruna Pasinato,Leonardo Grabinski Bottino,Gabriela H Telo,Jeruza Lavanholi Neyeloff,Beatriz D Schaan

doi:10.1186/s13098-019-0428-8

Abstract

BackgroundThis study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population.MethodsThis was a retrospective cohort of 488 patients with type 2 diabetes (148 in each primary health care unit, ESF and UBS, and 192 at the tertiary health care unit) with a 1-year follow-up to evaluate the following care quality indicators: nephropathy, neuropathy and retinopathy tests, yearly lipid profile and nutritional assessments, and an inquiry about tobacco use. The presence of > 50% of the quality of care assessment measures was considered acceptable. Indicators were also evaluated in relation to patients without proper diabetes control (HbA1c > 8.5%).ResultsIn the results, a high percentage of patients were excluded specifically for not presenting the two HbA1c tests within a year (n = 208, 58.1% at ESF; n = 225, 58.4% at UBS; and n = 39, 16.9% at the tertiary health care unit). From the included patients, only 7 (4.7%) at ESF, 7 (4.7%) at UBS, and 52 (27.0%) at the tertiary health care unit showed > 50% of the quality criteria covered. When only patients without proper diabetes control were evaluated, none of them at any of the health care units showed all the quality criteria covered.ConclusionsOur results show a low percentage of care assessment measures at each evaluated health care unit, pointing out the need to improve the protocols and care lines of diabetic patients.

Highlights

This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population
The purpose of this study is to describe and compare, through a set of indicators that are common to the diverse recommendations sources, the quality of type 2 diabetes patient care for people treated at different formats of primary care units (ESF and Unidade Básica de Saúde (UBS)) and at tertiary care units in Porto Alegre/ RS
This study included a final sample of 148 patients in each of the two primary health care segments (ESF and UBS) and 192 patients in the tertiary health care unit

Summary

Introduction

This study was developed to evaluate quality indicators in type 2 diabetes patient care at the Unified Public Health System’s primary and tertiary health care centers within a local population. Type 2 diabetes is a chronic and progressive disease with a high prevalence in the global population [1]. Treatment of this population within a health care system should stratify care based on disease severity and resource requirements; patients deemed “low complexity” should remain in primary care while patients who present metabolic imbalances after several treatment regimens, patients who use complex insulin schemes, or patients with advanced chronic complications who demand highly complex resources for their treatment are referred to institutions capable of meeting their demands [2]. The ESFs are responsible for coverage of all patients in a predetermined area, and the UBSs have spontaneous demands and/or demands referred by other services.

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