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BMC Health Services Research

, 13:232

Quality, performance, safety and outcomes

Abstract

BackgroundWhile Switzerland invests a lot of money in its healthcare system, little is known about the quality of care delivered. The objective of this study was to assess the quality of care provided to patients with diabetes in the Canton of Vaud, Switzerland.

MethodsCross-sectional study of 406 non-institutionalized adults with type 1 or 2 diabetes. Patients’ characteristics, diabetes and process of care indicators were collected using a self-administered questionnaire. Process indicators past 12 months included HbA1C check among HbA1C-aware patients, eye assessment by ophtalmologist, microalbuminuria check, feet examination, lipid test, blood pressure and weight measurement, influenza immunization, physical activity recommendations, and dietary recommendations. Item-by-item each process of care indicator: percentage of patients having received it, composite mean percentage of recommended care: sum of received processes of care - sum of possible recommended care, and all-or-none percentage of patients receiving all specified recommended care measures were computed.

ResultsMean age was 64.4 years; 59% were men. Type 1 and type 2 diabetes were reported by 18.2% and 68.5% of patients, respectively, but diabetes type remained undetermined for almost 20% of patients. Patients were treated with oral anti-diabetic drugs 50%, insulin 23% or both 27%. Of 219 HbA1C-aware patients, 98% reported ≥ one HbA1C check during the last year. Also, ≥94% reported ≥ one blood pressure measurement, ≥ one weight measurement or lipid test, and 68%, 64% and 56% had feet examination, microalbuminuria check and eye assessment, respectively. Influenza immunization was reported by 62% of the patients.

The percentage of patients receiving all processes of care ranged between 14.2%-16.9%, and 46.6%-50.7%, when considering ten and four indicators, respectively. Ambulatory care utilization showed little use of multidisciplinary care, and low levels of participation in diabetes-education classes.

ConclusionsWhile routine processes-of-care were performed annually in most patients, diabetes-specific risk screenings, influenza immunization, physical activity and dietary recommendations were less often reported; this was also the case for multidisciplinary care and participation in education classes. There is room for diabetes care improvement in Switzerland. These results should help define priorities and further develop country-specific chronic disease management initiatives for diabetes.

KeywordsHealthcare quality Diabetes Cross-sectional study AbbreviationsGDPGross domestic product

HbA1CHemoglobin A1C glycated hemoglobin

OADOral antidiabetic drugs

BMIBody mass index.

Electronic supplementary materialThe online version of this article doi:10.1186-1472-6963-13-232 contains supplementary material, which is available to authorized users.

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Author: Isabelle Peytremann-Bridevaux - Julie Bordet - Bernard Burnand

Source: https://link.springer.com/



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