The need for quality management in primary health care in Cyprus: results from a medical audit for patients with type 2 diabetes mellitus.

OBJECTIVES

To assess the quality of clinical management regarding metabolic and blood pressure control in a cohort of patients with type 2 diabetes in the primary health care setting of Cyprus.

SUBJECTS AND METHODS

Medical care, received by 296 patients with type 2 diabetes from 4 primary care health centers in Cyprus, was assessed for 1 year. Data were collected retrospectively using chart review and a telephone survey. Most recent values of HbA1c, fasting blood glucose, blood pressure, and lipid values were used to assess attainment to internationally accepted treatment targets.

RESULTS

Mean age was 70 years, 75% of patients being older than 65. Average diabetes duration was 13 years. Almost 90% of patients had visited a general practitioner during 1 year, on average 8.3 times. Hypertension and hyperlipidemia were present in 67% and 32% of patients, respectively. Overall, diabetes care provided by the 4 primary care health centers appeared to be suboptimal with regard to frequency of metabolic and blood pressure measurements as well as targets reached. Only 10.5% of all patients had at least 1 HbA1c value recorded, and 77.4% of them had HbA1c levels of 8% or more. Of the patients who had a low-density lipoprotein cholesterol measurement during the examined year (29.4%), only 20.7% had a value less than 100 mg/dL. Only 34.5% of patients used lipid-lowering agents, and only 15.9% were receiving aspirin.

CONCLUSION

Our findings suggest that the management of type 2 diabetes is suboptimal in the primary health care setting of Cyprus. A multifaceted intervention, already in progress in 2 health centers, is expected to improve the quality of diabetes care.