Sivas il merkezindeki sağlık ocaklarına müracaat eden tip 2 diyabet hastalarının diyabetik bakım kalitesini etkileyen önemli muayene ve tetkikler konusundaki bilgi ve uygulamaları
Knowledge and practices about important examination and studies affecting quality of diabetic care of patients with type II diabetes applying to health centers in Sivas
Yazar: YILMAZ SEÇKİN
Danışman: PROF.DR. R. EROL SEZER
Cumhuriyet Üniversitesi / Tıp Fakültesi / Aile Hekimliği Ana Bilim Dalı
Derece: Tıpta Uzmanlık, 2007
Konu: Aile Hekimliği = Family Medicine ; Endokrinoloji ve Metabolizma Hastalıkları = Endocrinology and Metabolic Diseases

Özet:
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term macrovascular, microvascular, and neuropathic complications. To reduce both the incidence and progression of diabetes-related complications in a community, diabetes care quality should be monitored and improved continuously. In spite of that there have been few studies published on diabetes care quality in Turkey. The purpose of this study to obtain baseline information, including patients' knowledge and skills, on the diabetes care in Sivas Province of Turkey through the patients who had type 2 diabetes for at least a year and presented to the primary care centers with any reason.In a period of three months (April-June 2007) the researcher visited all of the primary care centers in Sivas Provincial Center spending three consecutive days in each. After receiving their informed consent he interviewed, face to face and by means of a questionnaire, all of the patients with type 2 diabetes who presented to the primary care center with any reason between 9.00 and 12.00 am. He also measured blood pressures and collected blood samples for HbA1C measurements.The study subjects, 389 patients with type 2 diabetes from 19 primary care centers, had a mean age of 58,14 years (Minimum 34, maximum 85, standard deviation(SD): ±9.879). The mean age at diagnosis of diabetes was : 49.8 years [Minimum 26, maximum 82, SD: ±5.55, Confidence interval 95%: 49.8 ± 0.99 years]; The mean duration of diabetes since diagnosis 8.36 years (Minimum 1, Maximum 35, SD: ±6.5), and body mass index(BMI) 32.62 kg/m2(Minimum 19.44, maximum 56.27, SD: ± 5.55). Of the participants 55.5% were illiterate, % 78.9 females. Target HbA1c of <7% was observed in 19.5% of patients while 29.8% had very poor glycemic control with HbA1c of >10%. A history of hypertension was detected in 75.3% of the subjects. Of the diabetics 26.5% had blood pressure values at the target level of <130/80. Of the subjects 53.2% had self reported dilated eye exam, 12.3% foot exam, 9% proteinuria test, 1% HbA1C test in the last year, The proportion of persons reporting annual influenza vaccinations was 2.1%. Among the patients 40% were unable to state any symptom of hypoglycemia, of the insulin users this figure was 26.4%.These findings suggest that a wide gap exists between our knowledge of effective diabetes interventions and their implementation in practice in primary care settings in Sivas. Major public health, clinical and research efforts are needed to identify mechanisms at the patient, provider and health care system levels to improve the quality of diabetes care in primary care centers in Sivas Provincial Center and in similar places.Keywords: Type 2 diabetes, quality of care, primary care, Sivas

Abstract:
Diabetes is a chronic illness that requires continuing medical care and patient self-management education to prevent acute complications and to reduce the risk of long-term macrovascular, microvascular, and neuropathic complications. To reduce both the incidence and progression of diabetes-related complications in a community, diabetes care quality should be monitored and improved continuously. In spite of that there have been few studies published on diabetes care quality in Turkey. The purpose of this study to obtain baseline information, including patients? knowledge and skills, on the diabetes care in Sivas Province of Turkey through the patients who had type 2 diabetes for at least a year and presented to the primary care centers with any reason.In a period of three months (April-June 2007) the researcher visited all of the primary care centers in Sivas Provincial Center spending three consecutive days in each. After receiving their informed consent he interviewed, face to face and by means of a questionnaire, all of the patients with type 2 diabetes who presented to the primary care center with any reason between 9.00 and 12.00 am. He also measured blood pressures and collected blood samples for HbA1C measurements.The study subjects, 389 patients with type 2 diabetes from 19 primary care centers, had a mean age of 58,14 years (Minimum 34, maximum 85, standard deviation(SD): ±9.879). The mean age at diagnosis of diabetes was : 49.8 years [Minimum 26, maximum 82, SD: ±5.55, Confidence interval 95%: 49.8 ± 0.99 years]; The mean duration of diabetes since diagnosis 8.36 years (Minimum 1, Maximum 35, SD: ±6.5), and body mass index(BMI) 32.62 kg/m2(Minimum 19.44, maximum 56.27, SD: ± 5.55). Of the participants 55.5% were illiterate, % 78.9 females. Target HbA1c of <7% was observed in 19.5% of patients while 29.8% had very poor glycemic control with HbA1c of >10%. A history of hypertension was detected in 75.3% of the subjects. Of the diabetics 26.5% had blood pressure values at the target level of <130/80. Of the subjects 53.2% had self reported dilated eye exam, 12.3% foot exam, 9% proteinuria test, 1% HbA1C test in the last year, The proportion of persons reporting annual influenza vaccinations was 2.1%. Among the patients 40% were unable to state any symptom of hypoglycemia, of the insulin users this figure was 26.4%.These findings suggest that a wide gap exists between our knowledge of effective diabetes interventions and their implementation in practice in primary care settings in Sivas. Major public health, clinical and research efforts are needed to identify mechanisms at the patient, provider and health care system levels to improve the quality of diabetes care in primary care centers in Sivas Provincial Center and in similar places.Keywords: Type 2 diabetes, quality of care, primary care, Sivas