Evaluation of comprehensive program for diabetes care at primary health-care level.

The Swedish National Board of Health and Welfare published its first diabetes health-care program in 1977. The impact of the program was evaluated in the Stockholm County after 4 yr. The results showed that the educational program had reached greater than or equal to 1 staff member in 86% of the 104 primary health-care centers (PHCCs). Several organizational changes had taken place as a result of the program. The 10 "best" PHCCs were compared with a random sample of the centers with regard to patient outcomes. Patients from the 10 best centers had gotten a more comprehensive education, were more knowledgeable about foot care, tested glucose more often, and used less medication. The metabolic control was the same for both groups of patients. The PHCC staffs reported the following roadblocks to change: lack of knowledge of diabetes care, insufficient cooperation between staff members, poor contact with specialists, and absence of guidelines for diabetes care. The staffs in the best centers spent twice as much time in staff meetings and continuing education as those from the random sample of centers. The findings led us to formulate a new strategy for the program. The main objective of the new approach is to create organizational changes within the centers. Thus, local knowledge and creativity can be utilized. Preliminary data demonstrate that 84% of the locally developed plans for reorganization of diabetes care had been accomplished within 1 yr.