best practice study of diabetes type 2 management in primary care in switzerland

Conditions: Diabetes Mellitus, Type 2; Primary Care

Summary: this observational study intends to evaluate the use and adherence of different types of primary care practices to the diabetes criteria-protocol (diabetes score), developed by the swiss society of endocrinology and diabetology. this diabetes score comprises visits to the doctor, lifestyle consultations, clinical measures such as blood pressure, cholesterol or blood sugar, as well as measures concerning the prevention of secondary complications like kidney, eye or feet issues. the participating primary care practices need to treat 80% of their diabetes patients (their "diabetes population") in accordance to the score-criteria. in addition to the adherence to the eight score-criteria, the practices are required to also document statistically if their diabetes patients get the following medication: oral antidiabetics, insulin, blood pressure medication, statins and / flu vaccine. as this observational study is and before-and-after study, the primary care practices need to document for each of their diabetes patients the care they provided in the year before the introduction of the score-criteria and in the year following their introduction. participating primary care practices ask their diabetes patients' consent to the documentation and anonymous transmittance of their data. data evaluation is anonymous and on a population-based level (as opposed to individual-based). the hypothesis of the study is to prove that the implementation of evidence-based measures, such as a diabetes score can increase the treatment quality of diabetes patients in primary care practices and this increase is independent of the primary care practice structure in which it is applied.

information of the primary care practices regarding the background and goal of the project by means of a letter and informative documentation. recruitment of primary care practices, divided into three different practice organisations (individual practices and group practices run on a private basis and with financial autonomy, as well as forms of joint practices with employed physicians without financial autonomy). a signed contract between qualiccare and participating primary care practices regulates the collaboration. procedure: a baseline documentation takes place retrospectively from the training/workshop for the past 12 months, and a second, prospective documentation of the treatment is done during the following 12 months. training of the participating general practioners (gp) and practice coordinator on the project including evaluation software, data entry and background to the criteria. documentation of the treatment quality of all patients with diabetes mellitus type 2 in a practice structure that meets the inclusion criteria according to the score criteria (baseline). after 12 months, the treatment quality of the included patients with diabetes type 2 is recorded again using the same score.

Eligibility criteria:
inclusion criteria: * all patients in the primary care practice with a diabetes diagnosis, meaning their patient record shows that the patient either had an hba1c value higher than 6.4 percent, takes insulin or oral antidiabetics and is treated at least during nine months in the participating primary care practice. exclusion criteria: * treatment in participating primary care practice during less than nine months (due to change of primary care provider, death, diabetes treatment solely by specialist); * patients who do not give their patient consent to participate in study; * patients whom the primary care provider excludes from study due to frailty, end of life or other reasons.

Keywords: best practice optimisation of treatment diabetes score diabetes in primary care