Quality of care for patients with diabetes mellitus type 2 in ‘model practices’ in Slovenia – first results
| Autor: | Mitja Mlakar, Davorina Petek |
|---|---|
| Jazyk: | angličtina |
| Rok vydání: | 2016 |
| Předmět: |
medicine.medical_specialty
Referral media_common.quotation_subject kazalniki kakovosti Sample (statistics) Type 2 diabetes sladkorna bolezen tipa 2 kakovost oskrbe referenčne ambulante 03 medical and health sciences 0302 clinical medicine quality of care Diabetes mellitus medicine Quality (business) 030212 general & internal medicine media_common business.industry 030503 health policy & services Medical record Public Health Environmental and Occupational Health Retrospective cohort study model practice quality indicators medicine.disease Family medicine Cohort type 2 diabetes Public aspects of medicine RA1-1270 0305 other medical science business Research Article |
| Zdroj: | Slovenian Journal of Public Health, Vol 55, Iss 3, Pp 179-184 (2016) Slovenian Journal of Public Health |
| ISSN: | 1854-2476 |
| Popis: | A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices.A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared.The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort.The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.Referenčne ambulante predstavljajo novo organizacijsko obliko dela na primarni ravni. V njihovem timu sodeluje diplomirana medicinska sestra s podiplomskimi znanji, ki skrbi za register kroničnih bolnikov in bolnike aktivno vabi na redne kontrole. Samostojno opravlja nekatere postopke, kot je npr. pregled nog, in po protokolu dela sodeluje pri drugih postopkih oskrbe. Kakovost obravnave bolnikov s sladkorno boleznijo tipa 2 (SB2) je opredeljena z izbranimi procesnimi in izidnimi kazalniki kakovosti. Standardi kakovosti so postavljeni na 80% za procesne in na 50% za izidne kazalnike kakovosti. Večina raziskav potrjuje, da razširitev tima in prevzem nekaterih nalog v oskrbi sladkornih bolnikov s strani diplomirane medicinske sestre ne poslabša kakovosti oskrbe ali pa jo izboljša, če jo primerjamo z oskrbo, ki jo vodi le zdravnik družinske medicine. V raziskavi smo želeli ugotoviti kakovost vodenja sladkornih bolnikov pred uvedbo referenčnih ambulant in po njej.Izvedena je bila kohortna retrospektivna raziskava. Podatki so bili zbrani iz zdravstvenih kartotek bolnikov s SB2 iz treh ambulant družinske medicine. Primerjani so bili kazalniki kakovosti, med njimi meritve HbA1c, izveden je bil letni laboratorij (z določitvijo lipidov v plazmi, ocenjene glomerularne filtracije oz. kreatinina in urinske analize), opravljene so bile meritve krvnega tlaka, pregled nog in napotitev na pregled očesnega ozadja; ter ugotovljena je bila vrednost HbA1c pred uvedbo referenčnih ambulant in po njej.V vzorec je bilo vključenih 132 bolnikov, pri katerih je oskrba SB2 potekala izključno na primarni ravni. Proces oskrbe se je značilno izboljšal po uvedbi referenčnih ambulant. Najbolj sta v izboljšanju kakovosti izstopala rednost pregleda nog in rednost testiranja HbA1c, čeprav pa nista dosegla priporočenega standarda kakovosti 80%. Kljub doseženemu standardu kakovosti izidnega kazalnika 50% v tej kohorti ni bilo dokazano statistično pomembno izboljšanje glikemije (p0,1).Pred uvedbo referenčnih ambulant je bilo vodenje sladkornih bolnikov daleč od priporočenega. Vključitev diplomirane medicinske sestre v tim izboljša postopke kakovostne oskrbe. Priporočeni standardi za kazalnike kakovosti so dosegljivi. Boljšo urejenost glikemije in druge kakovostne izide oskrbe bolnikov bo treba še dokazati. |
| Databáze: | OpenAIRE |
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