A national program for diabetes care in general practice in Norway was produced in 1988 and revised in 1995.
There is evidence that an improved organisation will lead to a reduction of morbidity and mortality of micro and macrovascular disease. Hopefully, there is potential gain pertaining to the life quality of diabetic patients.
The project aims to establish a model for implementing the existing guidelines.
The indicators have been chosen to meet the following requirements as far as possible:
• Scientific validity
• Comprehensiveness as to the total care of diabetics
• Applicability in daily practice
• Inclusion of the patient perspective: The effect of the disease and the treatment on quality of life.
These describe how the organisation of the practice enable optimal diabetes care.
Do routines exist for
• Education of auxiliary staff, and distribution of responsibility between the doctor and his staff
• Follow up and control of diabetic patients.
• Accessibility for ad hoc patient questions/problems.
• Patient education groups.
These show whether procedures detecting risk factors or complications are carried out, in order to enable optimal interventions.
• Are individual treatment goals established?
• Is the patient referred to ophalmological examination according to guidelines?
• Have the patient’s feet been regularly examined?
• Have smoking habits been documented?
• Does the patient monitor her own blood glucose?
The result indicators show the results of variables directly related to the development of diabetic complications.
• HbA1c
• Microalbuminuria
• Blood pressure
• Smoking habits
• Body Mass Index
• Blood lipids
• Patient satisfaction with treatment. The diabetes treatment satisfaction questionnaire - DTSQ (Copyright Clare Bradley, 1993)
This indicator is compiled as the sum of scores for the following questions, and registers results of the total care with respect to quality of life.
On a scale 6-5-4-3-2-1-0 the following are scored by the patient:
1. How satisfied are you with your current treatment?
2. How often have you felt that your blood sugars have been unacceptably high recently?
3. How often have you felt that your blood sugars have been unacceptably low recently?
4. How convenient have you been finding your treatment to be recently?
5. How flexible have you been finding your treatment to be recently?
6. How satisfied are you with your understanding of your diabetes?
7. Would you recommend this form of treatment to someone else with your kind of diabetes?
8. How satisfied would you be to continue with your present form of treatment?
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