Dhanani Raheem H, Qureshi Mohammad Mustafa, Khuwaja Ali Khan, Ali Badar Sabir, Qureshi Riaz
Department of Family Medicine, Aga Khan University, Karachi, Pakistan.
J Ayub Med Coll Abbottabad. 2008 Apr-Jun;20(2):55-8.
Management of diabetes is a painstaking and careful approach. This study was aimed to evaluate the quality of care for the management of diabetes provided by family practitioners to their patients having diabetes. This is a retrospective audit of medical records conducted in a tertiary care teaching hospital of private sector in Karachi for one month.
For this study, 150 medical records of patients with type 2 diabetes that visited family practice clinics for their diabetes care were examined. A total of 88 patient's medical records were selected and analyzed who attended the studied clinics for at least one year and had minimum of four out-patient visits. Majority (68%) of the audited medical records were of females.
Of the total medical records analyzed, only one-quarter of the cases qualified the criteria of 'excellent' or 'good' diabetes care. Monitoring of body weight of the patient was only one indicator which was according the recommendations in 100% case at every visit. The other nearest quality of care indicator documented was blood glucose advice at every visit in 79.5% (95% CI: 71.1-87.9) of cases. Physical activity advised/reinforced at every visit was least observed (27.3%; 95% CI: 18.0-36.6). In addition, blood sugar control was reported in less than a quarter (23.9%) with 95% CI of 15.0-32.8.
This work has identified a big gap in the management of type 2 diabetes provided by family practitioners. In addition, majority of the patients found to have poor glycemic control. Interventions are suggested to improve the quality of diabetes care. More such audits and research are recommended at the larger scale.
糖尿病管理需要细致且谨慎的方法。本研究旨在评估家庭医生为糖尿病患者提供的糖尿病管理护理质量。这是在卡拉奇一家私立部门的三级护理教学医院进行的为期一个月的病历回顾性审计。
本研究检查了150份2型糖尿病患者前往家庭诊所进行糖尿病护理的病历。总共选择并分析了88份患者病历，这些患者在研究诊所就诊至少一年且至少有四次门诊就诊。大多数（68%）经审计的病历为女性。
在分析的所有病历中，只有四分之一的病例符合“优秀”或“良好”糖尿病护理标准。患者体重监测是唯一一项每次就诊均符合建议的指标。记录的另一项最接近护理质量的指标是79.5%（95%可信区间：71.1 - 87.9）的病例每次就诊时的血糖建议。每次就诊时建议/强化身体活动的情况最少见（27.3%；95%可信区间：18.0 - 36.6）。此外，报告血糖得到控制的病例不到四分之一（23.9%），95%可信区间为15.0 - 32.8。
这项工作发现了家庭医生在2型糖尿病管理方面存在巨大差距。此外，发现大多数患者血糖控制不佳。建议采取干预措施以提高糖尿病护理质量。建议在更大范围内进行更多此类审计和研究。
