Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India

• Authors: Roopa Shivashankar, Public Health Foundation of India; Sandeep Bhalla, Public Health Foundation of India; Dimple Kondal, Public Health Foundation of India; Mohammed Ali, Emory University; Dorairaj Prabhakaran, Public Health Foundation of India; Kabayam Venkat Narayan, Emory University; Nikhil Tandon, All India Institute of Medical Sciences
• Journal Title: Indian Journal of Endocrinology and Metabolism
• Volume: Volume 20, Number 3
• Publisher: Medknow Publications | 2016-05-01, Pages 329-336
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.4103/2230-8210.180000
• Subjects: Health Sciences, Health Care Management; Health Sciences, Public Health
• Keywords: Diabetes; India; primary care; quality of care; Endocrinology

Abstract

Aim: To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India. Methods: We interviewed physicians (n = 23) and patients with diabetes (n = 406), and reviewed patient charts at general practices (government = 5; private = 18). We examined diabetes care processes, specifically measurement of weight, blood pressure (BP), glycated hemoglobin (HbA1c), lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model. Results: The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7), and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model. Conclusion: Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.