University Public Health Center El Carmel-Barcelona, Department of Medicine, Universitat Autònoma de Barcelona, Unitat de Suport a laRecerca Barcelona Ciutat – IDIAP Jordi Gol, Institut Català de la Salut, c/ St Elies 42 Barcelona, Spain.
Prim Care Diabetes. 2012 Apr;6(1):11-8. doi: 10.1016/j.pcd.2011.06.005. Epub 2011 Jul 14.
To assess the implementation of St. Vincent recommendations in Catalonia (Spain) between 1993 and 2003 following a program of Continuous Quality Improvement.
65 health centres (433 health professionals) took part in the study. From 1993 to 2003, 34 workshops on consensus guidelines and feedback referring to the variables that needed to be improved were carried out. Data collection was obtained concerning, socio-demographic information, and disease characteristics and complications from patients with type 2 diabetes mellitus (DM).
Most cardiovascular risk factors improved: glycosilated haemoglobin (HbA1c) was reduced by 0.7% (95% CI: -0.49:-0.90); total cholesterol by 0.54mmol/L (95% CI: -0.53:-0.55); non-high density lipoprotein cholesterol by 0.81mmol/L (95% CI: -0.80:-0.82); systolic blood pressure (SBP) by 6.02mmHg (95% CI: -5.79:-6.25), and diastolic blood pressure (DBP) by 2.65mmHg (95% CI: -2.4:-2.9), with the exception of smoking and obesity, which increased by 2.1% and 5.9%, respectively. Retinopathy and albuminuria decreased by 40.7% and 46% (p<0.001), respectively. The incidence of diabetic foot lesions and amputations decreased by 65.7% and 61.1% (p<0.001), respectively. The prevalence of macrovascular complications showed a slight reduction (p=0.037). Ischemic cardiomyopathy and cerebrovascular accidents decreased by 7.7% and 17.6%, respectively.
Our Continuous Quality Improvement program based on St. Vincent recommendations, had a positive impact on cardiovascular risk factors. We observed a reduction of chronic complications in type 2 DM patients.
评估 1993 年至 2003 年期间，在连续质量改进计划下，西班牙加泰罗尼亚地区对圣文森特建议的实施情况。
65 家卫生中心（433 名卫生专业人员）参与了这项研究。1993 年至 2003 年期间，开展了 34 次关于共识指南的研讨会，并对需要改进的变量进行了反馈。收集了 2 型糖尿病患者的社会人口统计学信息、疾病特征和并发症的数据。
大多数心血管风险因素得到改善：糖化血红蛋白（HbA1c）降低了 0.7%（95%置信区间：-0.49：-0.90）；总胆固醇降低了 0.54mmol/L（95%置信区间：-0.53：-0.55）；非高密度脂蛋白胆固醇降低了 0.81mmol/L（95%置信区间：-0.80：-0.82）；收缩压（SBP）降低了 6.02mmHg（95%置信区间：-5.79：-6.25），舒张压（DBP）降低了 2.65mmHg（95%置信区间：-2.4：-2.9），但吸烟和肥胖率分别上升了 2.1%和 5.9%。视网膜病变和白蛋白尿分别下降了 40.7%和 46%（p<0.001）。糖尿病足病变和截肢的发生率分别下降了 65.7%和 61.1%（p<0.001）。大血管并发症的患病率略有下降（p=0.037）。缺血性心肌病和脑血管意外分别下降了 7.7%和 17.6%。
我们基于圣文森特建议的连续质量改进计划对心血管风险因素产生了积极影响。我们观察到 2 型糖尿病患者的慢性并发症有所减少。
