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Original article

Vol. 152 No. 2930 (2022)

Evaluation of type 2 diabetes care management in nine primary care practices before and after implementation of the Criteria of Good Disease Management of Diabetes established by the Swiss Society of Endocrinology and Diabetology 

  • Emanuel Christ
  • Astrid Czock
  • Frida Renström
  • Tamara Ammeter
  • Fahim Ebrahimi
  • Stefan Zechmann
  • Alexander Kutz
  • Peter Diem
  • Christian Häuptle
  • Michael Brändle
DOI
https://doi.org/10.4414/SMW.2022.w30197
Cite this as:
Swiss Med Wkly. 2022;152:w30197
Published
26.07.2022

Summary

AIMS OF THE STUDY: Little is known about the quality of diabetes management of patients with type 2 diabetes mellitus (T2DM) in Swiss primary care. Based on the recommendations of the National Council Quality Assurance Programme, an interprofessional working group of the Swiss Society of Endocrinology and Diabetology (SSED) established population-based national criteria for good disease management of T2DM in primary health care (the diabetes score). The objective of this study was to assess whether the implementation of these criteria improve diabetes management in primary care.

METHODS: The diabetes score comprises eight criteria including three biometric measurements, two lifestyle-specific items and screening of three diabetes-associated complications. Practices can evaluate adherence to the criteria based on a point system, with the recommended aim to achieve ≥70/100 points. Group practices and single practices were included in this study and started implementing the SSED criteria in January 2018. The resulting score was compared with data retrospectively obtained for 2017. The primary endpoint was the overall change in Diabetes Score between 2017 and 2018 at each practice, further stratified by practice type. The absolute effect on individual diabetes score criteria was assessed by pooling all patient-level data.

RESULTS: Nine practices (six single and three group) participated in the study. In 2017 and 2018, the primary care practices treated 727 and 704 patients with T2DM, respectively, of whom 676 were treated both years. Around half of the patients were cared for in group practices and half in single practices. Between 2017 and 2018 the median (interquartile range) diabetes score improved from 40 (35, 65) to 55 (45, 70; p = 0.078). One practice (single) obtained a score ≥70 in 2017, three practices (all single) achieved this target in 2018. Pooling patient-level data, we observed a significant absolute improvement in the following criteria: number of regular diabetes check ups, body mass index, glycated haemoglobin, blood pressure, low density lipoprotein cholesterol and screenings for diabetes-associated complications (all p <0.05). However, the extent of the improvements were often insufficient to reach the prefixed targets of the diabetes score criteria on the practice level.

CONCLUSION: Overall, the implementation of the SSED criteria in the current setting led to a modest, nonsignificant improvement of the diabetes score. Only three (all single practices) out of the nine practices reached the recommended 70-point target, indicating that further strategies are needed to improve diabetes care in primary care practice.

Trial registration: ClinicalTrials.gov (ID NCT04216875).

References

  1. Ogurtsova K, da Rocha Fernandes JD, Huang Y, Linnenkamp U, Guariguata L, Cho NH, et al. IDF Diabetes Atlas: global estimates for the prevalence of diabetes for 2015 and 2040. Diabetes Res Clin Pract. 2017 Jun;128:40–50. https://doi.org/10.1016/j.diabres.2017.03.024
  2. Narayan KM, Boyle JP, Geiss LS, Saaddine JB, Thompson TJ. Impact of recent increase in incidence on future diabetes burden: U.S., 2005-2050. Diabetes Care. 2006 Sep;29(9):2114–6. https://doi.org/10.2337/dc06-1136
  3. Go AS, Mozaffarian D, Roger VL, Benjamin EJ, Berry JD, Blaha MJ, et al. Heart Disease and Stroke Statistics - 2014 Update: A report from the American Heart Association. Circulation. 2014 Jan;129(3). https://doi.org/10.1161/01.cir.0000441139.02102.80
  4. Einarson TR, Acs A, Ludwig C, Panton UH. Economic Burden of Cardiovascular Disease in Type 2 Diabetes: A Systematic Review. Value Health. 2018 Jul;21(7):881–90. https://doi.org/10.1016/j.jval.2017.12.019
  5. Schimke KE, Renström F, Meier S, Stettler C, Brändle M ; SwissDiab Study Group. Compliance with guidelines for disease management in diabetes: results from the SwissDiab Registry. BMJ Open Diabetes Res Care. 2018 Feb;6(1):e000454. https://doi.org/10.1136/bmjdrc-2017-000454
  6. Peytremann-Bridevaux I, Bordet J, Burnand B. Diabetes care in Switzerland: good, but perfectible: a population-based cross-sectional survey. BMC Health Serv Res. 2013 Jun;13(1):232. https://doi.org/10.1186/1472-6963-13-232
  7. Eichmüller T, Renström F, Schimke K, Brändle M. Representativeness of the Swiss Diabetes Registry - a single centre analysis. Swiss Med Wkly. 2021 Jul;151(27–28):w20525. https://doi.org/10.4414/smw.2021.20525
  8. Gerber PA, Spirk D, Brändle M, Thoenes M, Lehmann R, Keller U. Regional differences of glycaemic control in patients with type 2 diabetes mellitus in Switzerland: a national cross-sectional survey. Swiss Med Wkly. 2011 Jul;141(JULY):w13218. https://doi.org/10.4414/smw.2011.13218
  9. Burgmann K, Fatio S, Jordi B, Rutishauser J. Medical care of type 2 diabetes mellitus in light of international and national recommendations: a retrospective analysis. Swiss Med Wkly. 2013 Oct;143:w13871. https://doi.org/10.4414/smw.2013.13871
  10. Huber CA, Scherer M, Rapold R, Blozik E ; Swiss Quality Indicator for Primary Care (SQIPRICA) Working Group members were. Evidence-based quality indicators for primary healthcare in association with the risk of hospitalisation: a population-based cohort study in Switzerland. BMJ Open. 2020 Apr;10(4):e032700. https://doi.org/10.1136/bmjopen-2019-032700
  11. Zuercher E, Diatta ID, Burnand B, Peytremann-Bridevaux I. Health literacy and quality of care of patients with diabetes: A cross-sectional analysis. Prim Care Diabetes. 2017 Jun;11(3):233–40. https://doi.org/10.1016/j.pcd.2017.02.003
  12. Canedo JR, Miller ST, Schlundt D, Fadden MK, Sanderson M. Racial/Ethnic Disparities in Diabetes Quality of Care: the Role of Healthcare Access and Socioeconomic Status. J Racial Ethn Health Disparities. 2018 Feb;5(1):7–14. [cited 2021 Jul 7] Available from: https://pubmed.ncbi.nlm.nih.gov/28078660/ https://doi.org/10.1007/s40615-016-0335-8
  13. Huber CA, Brändle M, Rapold R, Reich O, Rosemann T. A set of four simple performance measures reflecting adherence to guidelines predicts hospitalization: a claims-based cohort study of patients with diabetes [Internet]. Patient Prefer Adherence. 2016 Mar;10:223–31. [cited 2021 Jul 7] Available from: http://www.ncbi.nlm.nih.gov/pubmed/27042016 https://doi.org/10.2147/PPA.S99895
  14. Seitz P, Rosemann T, Gensichen J, Huber CA. Interventions in primary care to improve cardiovascular risk factors and glycated haemoglobin (HbA1c) levels in patients with diabetes: a systematic review. Diabetes Obes Metab. 2011 Jun;13(6):479–89. https://doi.org/10.1111/j.1463-1326.2010.01347.x
  15. Meier R, Chmiel C, Valeri F, Muheim L, Senn O, Rosemann T. The Effect of Financial Incentives on Quality Measures in the Treatment of Diabetes Mellitus: a Randomized Controlled Trial. J Gen Intern Med. 2021.
  16. Falck L, Zoller M, Rosemann T, Martínez-González NA, Chmiel C. Toward standardized monitoring of patients with chronic diseases in primary care using electronic medical records: systematic review. JMIR Med Inform. 2019 May;7(2):e10879. https://doi.org/10.2196/10879
  17. Meier R, Rachamin Y, Rosemann T, Markun S. The Impact of the 2019 European Guideline for Cardiovascular Risk Management: A Cross-Sectional Study in General Practice [Internet]. J Clin Med. 2020 Jul;9(7):E2140. [cited 2021 Jul 6] Available from: http://www.ncbi.nlm.nih.gov/pubmed/32645925 https://doi.org/10.3390/jcm9072140
  18. Rachamin Y, Markun S, Grischott T, Rosemann T, Meier R. Guideline Concordance of Statin Treatment Decisions: A Retrospective Cohort Study. J Clin Med. 2020 Nov;9(11):3719. https://doi.org/10.3390/jcm9113719
  19. Sahli R, Jungi M, Christ E. Goeldlin A. ««Chronic Care Management»-Programm in der hausärztlichen Praxis». Swiss Med Forum. 2019;19:113–6.
  20. Adler A, Agodoa L, Algra A, Asselbergs FW, Beckett NS, Berge E, et al.; Blood Pressure Lowering Treatment Trialists’ Collaboration. Pharmacological blood pressure lowering for primary and secondary prevention of cardiovascular disease across different levels of blood pressure: an individual participant-level data meta-analysis. Lancet. 2021 May;397(10285):1625–36. https://doi.org/10.1016/S0140-6736(21)00590-0

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