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Quality and effectiveness of diabetes care for a group of patients in Colombia

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Date
2009
Author
Machado-Alba, Jorge E
Moncada-Escobar, Juan C
Gaviria, Henry
Metadata
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Abstract
OBJECTIVE: To assess quality and effectiveness of diabetes care in a sample of Colombian diabetes patients treated by the national social security health system (SGSSS). METHODS: A retrospective study was conducted among 19 704 type 2 diabetes patients 30 years old who were SGSSS members, on pharmacological therapy, and treated at least twice by the SGSSS diabetes control program in one of nine cities from 1 July 2006 to 30 June 2007. A random sample of 406 was obtained. Using subjects' clinical history, the following factors were assessed: use of antidiabetic drugs and prescribed daily doses; use of antithrombotic therapies; additional medications; level and control of glycosylated hemoglobin (HbA1c), blood pressure, and cholesterol; urine albumin level; retinal and foot condition; and changes in medical regimens at most recent clinic visit. RESULTS: Annual risk factor testing rates were high (81.5 percent, HbA1c; 100 percent, blood pressure; 76.8 percent, total cholesterol), and a large proportion of patients were at target levels for HbA1c (42.9 percent 7.0 percent), blood pressure (66.2 percent 130/80 mmHg), and serum lipids (44.9 percent total cholesterol 200 mg/dL). However, only 6.9 percent were within recommended levels for all three risk factors. At most recent clinic visit, pharmaceutical regimens were adjusted for 39.7 percent, 58.2 percent, and 42.5 percent of patients above HbA1c, blood pressure, and cholesterol target levels, respectively. CONCLUSION: Despite high testing rates, metabolic control was not effective. Low rates of medication adjustment among patients with measures outside target ranges suggest the need for changes in routine diabetes care to ensure therapeutic regimens are adjusted appropriately.(AU)
 
OBJETIVO: Evaluar la calidad y la eficacia de la atención de la diabetes en una muestra de diabéticos colombianos tratados en el Sistema General de Seguridad Social en Salud (SGSSS). MÉTODOS: Estudio retrospectivo en 19 704 pacientes del SGSSS con tratamiento farmacológico para la diabetes tipo 2, mayores de 30 años y atendidos por el Programa de Control de la Diabetes del SGSSS al menos dos veces entre el 1 de julio de 2006 y el 30 de junio de 2007 en alguna de nueve ciudades. Se obtuvo una muestra aleatoria de 406 pacientes. A partir de sus historias clínicas se evaluaron los factores: consumo de medicamentos antidiabéticos y dosis diaria prescrita; tratamiento antitrombótico; medicamentos adicionales; nivel y control de la glucohemoglobina (HbA1c), presión arterial y colesterol; albuminuria; estado de los pies y la retina; y cambio de régimen terapéutico en la última consulta. RESULTADOS: Las tasas anuales de análisis relacionados con los factores de riesgo fueron elevadas (HbA1c: 81,5 por ciento, tensión arterial: 100 por ciento y colesterol total: 76,8 por ciento) y una alta proporción de los pacientes alcanzaron los valores recomendados de HbA1c 7,0 por ciento (42,9 por ciento), tensión arterial 130/80 mm Hg (66,2 por ciento) y colesterol total 200 mg/dL (44,9 por ciento). Sin embargo, solo 6,9 por ciento de los pacientes tenían los niveles recomendados en los tres factores de riesgo. En la última consulta, se ajustó el régimen farmacológico a 39,7 por ciento, 58,2 por ciento y 42,5 por ciento de los pacientes que presentaban valores alterados de HbA1c, tensión arterial y colesterol, respectivamente. CONCLUSIONES: A pesar de la alta tasa de análisis, el control metabólico no fue eficaz. La baja tasa de ajuste del tratamiento de los pacientes con resultados fuera del rango recomendado indica que es necesario cambiar el procedimiento habitual de atención de los pacientes diabéticos para garantizar el adecuado ajuste de los regímenes...(AU)
 
Series
Rev Panam Salud Publica;26(6),dic. 2009
Subject
Diabetes Mellitus; Effectiveness; Quality of Health Care; Colombia; Diabetes Mellitus; Efectividad; Calidad de la Atención de Salud; Colombia; Diabetes Mellitus; Qualidade da Assistência à Saúde; Colômbia; Análise Multivariada; Estudos Retrospectivos
URI
http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892009001200008
https://iris.paho.org/handle/10665.2/9733
Citation
Machado-Alba, Jorge E,Moncada-Escobar, Juan C,Gaviria, Henry (2009) Quality and effectiveness of diabetes care for a group of patients in Colombia. Rev Panam Salud Publica;26(6) 529-535,dec. 2009. Retrieved from http://www.scielosp.org/scielo.php?script=sci_arttext&pid=S1020-49892009001200008
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  • Pan American Journal of Public Health

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