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"Damm Sokkor"* Factors associated with the quality of care of patients with diabetes: A study in primary care in Tunisia (*Damm = blood pressure, Sokkor = diabetes, in Arabic)

DSSB (Direction des Soins de Santé de Base), [Primary Health Care Department, Ministry of Public Health], 31 Rue Khartoum, Tunis, Tunisia

Hugh.alberti{at}newcastle.ac.uk

ABSTRACT

Objective: To identify the organisational, physician and patient factors associated with the quality of care of patients with diabetes in a low/middle income country.

Research Design and Methods: Data from 2160 randomly selected patients with diabetes were extracted from the manual medical records of a nationwide sample of 48 randomly selected health centres. Physician and organisational characteristics were collected from national reports, questionnaires, interviews and observation at the centres. Univariate and multivariate regression analyses were undertaken to identify associations with four quality of care scores, based on processes and intermediate outcomes of care, and 53 potential explanatory factors.

Results: The mean age of the study population was 62.4years, mean duration of diabetes was 8.4years, 62% were female and 94% had type 2 diabetes. In the final multivariate models, factors independently and significantly associated with higher process of care scores were regional affluence, doctor motivation and the use of chronic disease clinics (p<0.05). Health centres with younger patients and increased availability of medication were independently and significantly associated with improved outcome of care scores (p<0.05). The final models of the 4 quality of care scores explained 55-71% of the variations in scores.

Conclusions: Use of chronic disease clinics, availability of medication and possibly doctor motivation, appear to be the most strongly related modifiable factors influencing diabetes care. These findings will be used to develop and implement culturally appropriate, quality improvement interventions to improve the quality of diabetes care. We recommend our findings be taken into account in other low/middle income countries.

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