Measures of psychological well-being and treatment satisfaction developed from the responses of people with tablet-treated diabetes

Monitoring the targets of the St Vincent Declaration and the implementation of quality management in diabetes care: the DIABCARE initiative. The DIABCARE Monitoring Group of the St Vincent Declaration Steering Committee

The St Vincent Declaration, a joint initiative on diabetes care and research of the World Health Organization (Europe) and the International Diabetes Federation (Europe), includes 5-year targets for improvement in diabetes outcomes as a central tenet. Accordingly, the establishment of state of the art monitoring and control systems is urged as a basis for the implementation of quality management. As a prerequisite for both targets, a diabetes dataset (fields and definitions) has been agreed to allow common monitoring of diabetes throughout Europe. This dataset has been further developed as the foundation stone of DiabCare, an initiative for continuous quality development in diabetes care. In a formal consensus process using the Delphi method, over 130 European diabetologists from 21 countries contributed to the development of this dataset, which includes fields covering true patient outcomes, intermediate metabolic outcomes, markers of diabetes tissue damage, risk factors, pregnancy, and life-style. The tools for documentation of the quality of health status have been developed in three formats for use in different health care settings. These tools, the DiabCare Diabetes Dataset, the DiabCare Basic Information Sheet, and the DiabCare Computer Program, are designed to allow local feedback-driven improvement in the quality of care, but are also the subject of communication protocols to compare performance between centres, regions, and countries. Whether implemented with or without the benefits of modern information technology, these initiatives can be the basis for both monitoring the targets of the St Vincent Declaration and for implementation of continuing quality development in diabetes care.

A proposal for continuing audit of diabetes services. Home and Members of a Working Group of the Research Unit of the Royal College of Physicians and British Diabetic Association

A working group was established in order to suggest the process and outcome variables most appropriate for the continuing audit of diabetes services. The proposed audit is being piloted in hospitals in selected United Kingdom Health Districts. The main process and outcome measures suggested are: waiting and consultation times; missed or cancelled appointments; information given to patients and the primary care team; knowledge of diabetes and risks of smoking; recording of key examinations and investigations, i.e. levels of glycosylated haemoglobin (or equivalent), serum cholesterol, body mass index, blood pressure, albumin excretion rate, presence and extent of retinopathy, history of coronary artery, cerebrovascular or peripheral vascular disease; history of severe hypoglycaemia; presence of foot problems; psychological well-being; patient satisfaction; admission rates and hospital bed days for hyperglycaemic and other diabetes related emergencies.

Scales to measure perceived control developed specifically for people with tablet-treated diabetes

Scales to measure perceived control of tablet-treated diabetes were adapted from a measure designed previously for insulin users. Development of the new scale is described and the psychometric properties are examined with responses from 187 tablet-treated patients. The scales consist of seven subscales which may be combined to provide three composite scores indicating the extent to which respondents perceive Personal Control, Medical Control, and Situational Control over their diabetes. Relationships between subscales and composite scores were similar to those found previously for insulin users. Patients were significantly more likely (p less than 0.001) to make attributions to Personal Control for their diabetes management rather than to Medical or Situational Control. As before, predictable biases were found in attributions to positive and negative outcomes. Correlations with medical and other psychological variables indicated that, as expected, stronger perceptions of Personal Control were associated with lower HbA1 levels (r = -0.14; p less than 0.05), lower percent ideal body weight (r = -0.24; p less than 0.01), less Anxiety (r = -0.15; p less than 0.05), greater Positive Well-being (r = 0.21; p less than 0.01) and greater Satisfaction with treatment (r = 0.34; p less than 0.001). Complementary relationships were found with the measure of Situational Control. Wallston and Wallston's speculative Locus of Control typology was investigated using the new measures, and the findings provided support for the value of this approach.