Alberti H, Boudriga N, Nabli M. "Damm sokkor": factors associated with the quality of care of patients with diabetes: a study in primary care in Tunisia.
Diabetes Care 2007;
30:2013-8. [PMID:
17507697 DOI:
10.2337/dc07-0520]
[Citation(s) in RCA: 17] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE
To identify the organizational, physician, and patient factors associated with the quality of care of patients with diabetes in a low-/middle-income country.
RESEARCH DESIGN AND METHODS
Data from 2,160 randomly selected patients with diabetes were extracted from the manual medical records of a nationwide sample of 48 randomly selected health centers. Physician and organizational characteristics were collected from national reports, questionnaires, interviews, and observation at the centers. Univariate and multivariate regression analyses were undertaken to identify associations with four quality-of-care scores, based on processes and intermediate outcomes of care and 53 potential explanatory factors.
RESULTS
The mean age of the study population was 62.4 years, mean duration of diabetes was 8.4 years, 62% were female, and 94% had type 2 diabetes. In the final multivariate models, factors independently and significantly associated with higher process-of-care scores were regional affluence, doctor motivation, and the use of chronic disease clinics (P < 0.05). Health centers with younger patients and increased availability of medication were independently and significantly associated with improved outcome-of-care scores (P < 0.05). The final models of the four quality-of-care scores explained 55-71% of the variations in scores.
CONCLUSIONS
Use of chronic disease clinics, availability of medication, and possibly doctor motivation appear to be the most strongly related modifiable factors influencing diabetes care. These findings will be used to develop and implement culturally appropriate quality improvement interventions to improve the quality of diabetes care. We recommend our findings be taken into account in other low-/middle-income countries.
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