The relationship between primary health care organization and quality of diabetes care

Figures & data

Appendix 1: Questionnaire about organization of diabetes care, given to one GP and NP of each primary health care centre

1.	Who performs the three monthly check-ups in your health centre? (several answers possible)
	○ Receptionist
	○ Nurse practitioner
	○ General practitioner
	○ External organization
	○ No three monthly check-ups are performed
2.	Who performs the yearly check-ups in your health centre? (several answers possible)
	○ Receptionist
	○ Nurse practitioner
	○ General practitioner
	○ External organization
	○ No yearly check-ups are performed
3.	Do the general practitioner and the nurse practitioner structurally consult on every patient seen by the nurse practitioner?
	○ Yes
	○ No
4.	Do you treat patients using insulin in your health centre?
	○ No
	○ Yes, but only 1 dd = daily dose regimes
	○ Yes, all regimes, including 2 en 4 dd = daily dose
5.	Are all type 2 diabetic patients seen by the nurse practitioner or a certain selection?
	○ All patients with type 2 diabetes mellitus
	○ A certain selection, namely ...
6.	Are measures taken in case a patient does not show up for one or more check-ups? If so, which one(s)? (several answers possible)
	○ No measures are taken
	○ It is noted down in the patient record
	○ The patients is called
	○ The patient is sent a letter, reminding him/her he/she has to attend the check-up
	○ Wait until the next check-up and then ask for the reason of his/her absence
	○ Otherwise, namely ...
7.	Do you have a patient diabetes education program in your health centre?
	○ Yes
	○ No
8.	Do you have consulting hours specifcally for diabetes in your health centre?
	○ Yes
	○ No
9.	Are any aids available in your health centre for structuring/improving the diabetes care? If so, which one(s)?
	○ No aids are available
	○ Diabetes passport
	○ Report cards
	○ Call up and registration system
	○ Statistical software
	○ Practice protocol for diabetes
	○ Others, namely ...
10.	Do you have structured and regular multidisciplinary collaboration concerning diabetes care in your health centre? If so, which discipline(s) take part in this collaboration?
	○ There is no multidisciplinary collaboration
	○ Receptionist
	○ Nurse practitioner
	○ General practitioner
	○ External diabetic nurses
	○ Dietician
	○ Physiotherapist
	○ Ergotherapist
	○ Podology specialist
	○ Endocrinologist
	○ Others, namely ...

Table I. Baseline characteristics of the study population

Baseline characteristics	Number (%) or mean ± SD
Demographics
Age (years)	67 ± 12
Male gender	901 (49%)
Family history
CHD	111 (6%)
DM	290 (16%)
Both CHD and DM	46 (3%)
Duration of diabetes (years)	6 ± 6.5
Co-morbidity
Nephropathy	238 (13%)
Retinopathy	121 (7%)
Neuropathy	101 (6%)
Diabetic foot	13 (0.7%)
Amputation	12 (0.6%)
Coronary heart disease	425 (23%)
Cerebral vascular disease	181 (10%)
Peripheral artery disease	119 (6%)
Diabetic medication
Diet only	388 (21%)
Oral anti diabetics only	1179 (64%)
Insulin only	113 (6%)
Both insulin and oral anti diabetics	169 (9%)
Co-medication
Antihypertensive medication	1379 (75%)
Statins	1295 (70%)
Anticoagulants (aspirin included)	753 (41%)

CHD, coronary heart disease; DM, diabetes mellitus

Figure 1. Selection procedure patient population. HCC, health care centre

Table II. Percentages of patients of the different health care centres (HCCs) who received diabetes care according to the Dutch guidelines for general practice.

	SBP ≥ 1× (%)	Weight ≥ 3× (%)	HBA1c ≥ 1× (%)	Lipids ≥ 1×(%)	Creatinin ≥ 1×(%)	Proteinuria ≥ 1×(%)	Eye exam. ≥1×/2 years (%)	Foot exam. ≥ 1× (%)
Netherlands (17)	85	?	72	71	69	?	63	35
Overall	92	59	83	77	82	63	71	63
HCC 1	83	21	84	70	82	68	56	46
HCC 2	91	75	88	83	88	80	67	70
HCC 3	88	52	79	53	73	27	66	44
HCC 4	92	45	86	76	68	56	70	41
HCC 5	95	84	90	92	92	71	90	86
HCC 6	99	73	83	80	85	76	67	79
HCC 7	97	79	97	96	85	71	90	52
HCC 8	89	44	66	65	72	48	71	66
HCC 9	87	46	83	76	80	54	61	61
HCC 10	96	77	89	88	90	85	87	85

HCC, Health care centre

Figure 2. Percentage of patients per health care centre (HCC) with an optimal quality of care index (QoC-index = 8) in 2006.

Table III. Association of organizational aspects of diabetes care given to patients with the optimal quality of care index (QoC-index = 8).

Simple analysis of organizational aspects			Multilevel and multivariate analysis of Organizational aspects
organizational aspects		% Patients with QoC index = 8	Odds ratio for QoC index = 8	95% CI-interval
Diabetes education programme^a	Yes	34%*	4.29*	3.40-5.41
	No	28%*	1.00
Multidisciplinary collaboration	Yes	32%	1.05	0.91-1.22
	No	29%	1.00
Yearly check-up by	GP and NP	46%*	5.51*	4.16-7.30
	GP or NP	24%*	1.00
Planned that after the patient visited the	Yes	37%*	1.80*	1.62-2.00
NP the patient is discussed with the GP	No	17%*	1.00
Active measures taken in case a patient does not show up	1 active measure	63%*	0.65*	0.47-0.89
	2 active measures	20%*	0.59*	0.50-0.69
	3 active measures	46%*	1.00
Aids for structuring diabetes care
Report cards	Yes	30%	0.75	0.22-2.59
	No	32%	1.00
Call-up and registration system	Yes	34%*	2.37	0.97-7.96
	No	22%*	1.00
Protocol diabetes care	Yes	35%*	1.61	0.62–4.19
	No	23%*	1.00

^*P< 0.05

^aA diabetes education programme is separate from the regular diabetes check-ups. It gives the patient specifc information about the

Dijkstra R, Bouma M. Werken aan kwaliteit in de huisartsen-praktijk [Working at quality in general practice] Chapter 4: Diabetes Mellitus. Houten: Bohn Stafleu Van Loghum; 2005.

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