<abstract xmlns="http://www.w3.org/1999/xhtml"><sec id="j_sjph-2016-0023_s_333_w2aab3b8c19b1b7b1aab1c15b1Aa"><h3>Background</h3><p>A new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices.</p></sec><sec id="j_sjph-2016-0023_s_334_w2aab3b8c19b1b7b1aab1c15b2Aa"><h3>Methods</h3><p>A cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared.</p></sec><sec id="j_sjph-2016-0023_s_335_w2aab3b8c19b1b7b1aab1c15b3Aa"><h3>Results</h3><p>The final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort.</p></sec><sec id="j_sjph-2016-0023_s_336_w2aab3b8c19b1b7b1aab1c15b4Aa"><h3>Conclusion</h3><p>The introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.</p></sec></abstract>

BackgroundA new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the team. Nurse practitioners are in charge of registers of chronic patients, and implement an active approach into medical care. Selected quality indicators define the quality of management. The majority of studies confirm the effectiveness of the extended team in the quality of care, which is similar or improved when compared to care performed by the physician alone. The aim of the study is to compare the quality of management of patients with diabetes mellitus type 2 before and after the introduction of model practices.MethodsA cohort retrospective study was based on medical records from three practices. Process quality indicators, such as regularity of HbA1c measurement, blood pressure measurement, foot exam, referral to eye exam, performance of yearly laboratory tests and HbA1c level before and after the introduction of model practices were compared.ResultsThe final sample consisted of 132 patients, whose diabetes care was exclusively performed at the primary care level. The process of care has significantly improved after the delivery of model practices. The most outstanding is the increase of foot exam and HbA1c testing. We could not prove better glycaemic control (p>0.1). Nevertheless, the proposed benchmark for the suggested quality process and outcome indicators were mostly exceeded in this cohort.ConclusionThe introduction of a nurse into the team improves the process quality of care. Benchmarks for quality indicators are obtainable. Better outcomes of care need further confirmation.

Quality of care for patients with diabetes mellitus type 2 in ‘model practices’ in Slovenia – first results

University of Ljubljana, Faculty of Medicine, Department of Family Medicine, Poljanski nasip 58, 1000 Ljubljana,

Community Medical Center Maribor, Ulica talcev 9, 2000 Maribor,

Slovenian Journal of Public Health

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

KAKOVOST OSKRBE BOLNIKOV S SLADKORNO BOLEZNIJO TIPA 2 V REFERENČNIH AMBULANTAH - PRVI REZULTATI

BackgroundA new organisation at the primary level, called model practices, introduces a 0.5 full-time equivalent nurse practitioner as a regular member of the...

Quality indicators	Before model practices No (%)	After model practices No (%)	X²	P
Measured HbA1c	33 (25)	108 (82)	43.32	<0.01
Laboratory tests if all lab tests (except HbA1c) were performed at least once per year (creatinine, oGFR, serum lipids, urine dip-sticks, serum glucose)	51 (39)	99 (75)	40.50	<0.01
Foot exam	9 (7)	90 (68)	75.00	<0.01
Eye exam	59 (45)	120 (91)	51.57	<0.01
Measured blood pressure	117 (89)	125 (95)	3.030	n.s.
Annual examination	59 (45)	119 (90)	49.73	<0.01

HbA1c (%) before model practices		HbA1c (%) after model practices		t(df)	P
M	SD	M	SD	t(df)	P
7.60	1.32	7.33	1.21	1.08(33)	n.s.

Quality of care for patients with diabetes mellitus type 2 in ‘model practices’ in Slovenia – first results

Article Category: Research article

Published Online: May 10, 2016

Page range: 179 - 184

Received: Aug 07, 2015

Accepted: Feb 15, 2016

DOI: https://doi.org/10.1515/sjph-2016-0023

© National Institute of Public Health, Slovenia

This work is licensed under the Creative Commons Attribution-NonCommercial-NoDerivatives 3.0 License.

The share of patents with DM2 according to process quality indicators before and after the introduction of model practices.

HbA1c levels in DM2 patients before and after the introduction of model practices (N=33).