Dunn N R, Bough P
Br J Gen Pract. 1996 Jul;46(408):401-5.
Poole has a well-established system of sharing care of patients with diabetes between hospital and general practitioners. Very few comprehensive audits of the effectiveness of such a system, which is being adopted in many areas of the UK, have been carried out.
A study was set up to survey structure, process and outcome of care for as many diabetic patients in the Poole area as possible, and to feed the results back to individual practices.
Structure criteria were assessed by self-completion questionnaire. Process and outcome criteria were assessed by visits to practices and examination of individual patient notes. A total of 37 practices were visited and the notes of 3974 patients reviewed. Results were analysed by practice and for the district as a whole, and were sent to each practice for comparison.
The overall prevalence of diabetes in the area was 1.61%, with a marked preponderance of elderly patients (14.1% were over 80). The overall male to female ratio was 1.2:1. The structure questionnaire pinpointed deficiencies in audit facilities, completeness of diabetic registers, and in general use of optometrists and chiropodists. Process criteria analysis showed that, within the last 13 months, 44% of patients under sole care of a general practitioner had undergone full eye examination, cholesterol levels had been checked in 25%, smoking status in 50%, and some foot inspection had been carried out in 57%. Glycaemic control and blood pressure had been measured in over 75% of patients. Outcome analysis showed, in those patients in which they were measured, mean glycosylated haemoglobin (Hba1c) to be 8.07% (upper limit of normal, ULN = 6.5%), some degree of retinopathy to be present in 17.3%, hypertension in 27%, and hypercholesterolaemia in 33%.
Standards of care of diabetics by general practitioners in the Poole area are not optimal, although they are as good as those reported for other districts. Glycaemic control was generally poor, especially in those patients needing insulin to control the disease. Vascular disease risk factors need to be targeted, and eye examination systems and chiropody services improved.
普尔地区已建立起完善的医院与全科医生共同护理糖尿病患者的体系。在英国许多地区都采用了这样的体系，但对其有效性进行的全面审计却很少。
开展一项研究，尽可能多地调查普尔地区糖尿病患者的护理结构、过程和结果，并将结果反馈给各个医疗机构。
通过自我填写问卷评估结构标准。通过走访医疗机构和检查个体患者记录来评估过程和结果标准。共走访了37家医疗机构，查阅了3974名患者的记录。对结果按医疗机构和整个地区进行分析，并将结果发送给每家医疗机构以供比较。
该地区糖尿病的总体患病率为1.61%，老年患者占比显著（14.1%年龄超过80岁）。总体男女比例为1.2:1。结构问卷指出了审计设施、糖尿病登记册的完整性以及验光师和足病医生的普遍使用方面存在的不足。过程标准分析表明，在过去13个月内，由全科医生单独护理的患者中，44%接受了全面眼部检查，25%检查了胆固醇水平，50%检查了吸烟状况，57%进行了一些足部检查。超过75%的患者测量了血糖控制和血压。结果分析表明，在测量的患者中，平均糖化血红蛋白（Hba1c）为8.07%（正常上限，ULN = 6.5%），17.3%存在某种程度的视网膜病变，27%患有高血压，33%患有高胆固醇血症。
普尔地区全科医生对糖尿病患者的护理标准并非最佳，尽管与其他地区报告的标准相当。血糖控制总体较差，尤其是在那些需要胰岛素控制病情的患者中。需要针对血管疾病风险因素，改善眼部检查系统和足病服务。
