The need for quality management in primary health care in Cyprus: Results from a medical audit for patients with type 2 diabetes mellitus

OBJECTIVES: To assess the quality of clinical management regarding metabolic and blood pressure control in a cohort of patients with type 2 diabetes in the primary health care setting of Cyprus. SUBJECTS AND METHODS: Medical care, received by 296 patients with type 2 diabetes from 4 primary care health centers in Cyprus, was assessed for 1 year. Data were collected retrospectively using chart review and a telephone survey. Most recent values of HbA1c, fasting blood glucose, blood pressure, and lipid values were used to assess attainment to internationally accepted treatment targets. RESULTS: Mean age was 70 years, 75% of patients being older than 65. Average diabetes duration was 13 years. Almost 90% of patients had visited a general practitioner during 1 year, on average 8.3 times. Hypertension and hyperlipidemia were present in 67% and 32% of patients, respectively. Overall, diabetes care provided by the 4 primary care health centers appeared to be suboptimal with regard to frequency of metabolic and blood pressure measurements as well as targets reached. Only 10.5% of all patients had at least 1 HbA1c value recorded, and 77.4% of them had HbA1c levels of 8% or more. Of the patients who had a low-density lipoprotein cholesterol measurement during the examined year (29.4%), only 20.7% had a value less than 100 mg/dL. Only 34.5% of patients used lipid-lowering agents, and only 15.9% were receiving aspirin. CONCLUSION: Our findings suggest that the management of type 2 diabetes is suboptimal in the primary health care setting of Cyprus. A multifaceted intervention, already in progress in 2 health centers, is expected to improve the quality of diabetes care.