Quality of Care for Diabetic Patients in Diabetes Clinic of Ratchaphiphat Hospital According to the Clinical Practice Guideline

Abstract

Objectives: To compare the quality of care and outcomes of treatment of diabetic patients, taken care by general practitioner and internal medicine specialists, in Diabetes Clinic of Ratchaphiphat Hospital according to the clinical practice guideline for diabetes 2011.

Methods: This study was a historical cohort study. Medical records of the diabetes patients who attended the Diabetes Clinic, Ratchaphiphat Hospital during July 1, 2010 to September 30, 2011 were reviewed. Inclusion criteria were age over 15 and attended the clinic ณ 5 times during a minimum of 15 months. The study group consisted of 170 diabetes patients who were treated by general practitioners. The control group were 170 diabetes patients who were treated by internal medicine specialists, and had the nearest hospital number to the study group.

Results: The mean age of the study and control groups were 63.5 ฑ 10.2 years and 63.2 ฑ 10.6 years, respectively. The mean duration of patients being diagnosed as diabetic in the study group was significantly shorter than the control group, 5.5 ฑ 3.1 vs 6.9 ฑ 3.3 years. Insulin treatment was used in the study group significantly less than the control group (18.2% vs 38.2%). Concerning the quality of care, the general follow up guidelines were comparable in both groups. Frequency of follow-up schedule of at least every 3 months (97.1% vs 95.9%), blood sugar evaluated at every visit (90.0% vs 91.8%), HbA1c evaluated of at least once a year (91.2% vs 95.3%), and lipid profile evaluated of at least once a year (99.4% vs 100.0%) were similarly practice in both groups. The study group had the assessment of complications in terms of foot examination (22.4% vs 37.6%), eye examination (37.1% vs 60.0%) and urine examination for microalbuminuria or urine/creatinine ratio (74.7% vs 94.1%) significantly less than the control group. However, diabetes control including the complications of diabetes were comparable, although more patients in the control group had blood pressure controlled. The study group had HbA1c blood sugar and blood pressure controlled in 31.8%, 41.2%, and 54.1% respectively compared to 28.8%, 32.9%, and 65.9% in the control group. The study group developed kidney disease, diabetes foot, diabetes retinopathy, cerebral vascular diseases and coronary artery diseases during the study period in 9.1%, 4.7%, 1.8%, 2.4% and 1.8%, respectively compared to 10.0%, 4.1%, 0.6%, 0.6% and 1.4% in the control group, respectively.

Conclusion: The quality of basic care for the diabetic patients based on clinical practice guidelines by the general practitioner was comparable to care provided by the internal medicine specialists but lower in terms of complication assessments and blood pressure controlled. However; the diabetes control and complications of diabetes were not different.

Keywords: diabetes, diabetes guideline, general practitioner, internal medicine specialist