Evaluation of quality of clinical diabetes care in integrated physician-nurse clinic in government health center

Abstract EN

Objective : To examine the quality of clinical care provided to type 2 diabetes patients attending the newlyestablished integrated physician nurse diabetic clinic in a governmental primary health care centre.

Methods : A retrospective, cross-sectional medical audit, based on data extrapolated from medical records.

Inclusion criteria were determined.

A data collection check list collected information related to the quality of care, based on performance clinical indicators extrapolated from new General Medical Services (GMS) contract.

Results : A total of 118 (38 male and 80 female) diabetic subjects fulfilled the inclusion criteria of the audit.

The mean age was 49.5 + 9.5 years, the majority being Bahrainis (98.3 %).

Approximately half (47.5 %) of the subjects were hypertensive, two thirds (69.5 %) were hyperlipidemic, and 46 % were obese.

The performance against most of the quality clinical indicators reached, and even exceeded the maximum thresholds set out by the new GMS contract.

The performance against 4 out of the 18 indicators was sub-standard ; the lowest related to the influenza immunization of diabetic patients (2.5 %) followed by smoking cessation advice given to smoker patients (34.5 %).

Glycemic control (HbA1c < 7.0) was achieved in 35.1 % of the subjects.

Whereas blood pressure < 145 / 85 mmHg was maintained in 71 % of hypertensive subjects, the American Diabetic Association (ADA) recommended target of BP < 130 / 80 mmHg in diabetes was attained in 23.9 % of subjects.

The level of lipid control recommended by National Institute for Clinical Excellence (NICE) guideline H and new GMS contract was achieved in 60.2 % of diabetic patients.

Screening for microvascular complications and treating micro-albuminurea with ACE or / and ARBs were optimal, and were in line with the new GMS contract recommendation.

Conclusion : An integrated physician-nurse team provides optimal care to patients attending diabetic clinics, a consequence of the presence of highly motivated clinic nurses and physicians, the protected time, and availability of a checklist (diabetic sheet) at the time of patient’s review.

Thus it is possible to recommend the wider adoption of this setup to all primary healthcare centres.