Abstract

Objective: To investigate the role of clinical and socio-economic variables as determinants of adherence to recommended diabetes care guidelines, and assess differences in the process of care between diabetologists and General Practitioners (GPs).

Research Design and Methods: We identified diabetic residents in Torino, Italy, as at 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent twelve months and performed regression analyses to identify associations with quality of care indicators based on existing guidelines.

Results: After one year only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age ≥ 75 years (Prevalence Rate Ratio (PRR) 0.66; 95% CI 0.61-0.70) and established cardiovascular disease (PRR 0.89; 0.86-0.93). Disease severity (PRR for insulin-treated patients 1.45; 1.38-1.53) and diabetologist consultation (PRR 3.34; 3.17-3.53) were positively associated with high quality of care. No clear association emerged between gender and socio-economic status. These differences were strongly reduced in patients receiving diabetologist care, compared with patients receiving GP care only.

Conclusions: Despite widespread availability of guidelines and simple screening procedures, a non-negligible portion of the diabetic population, namely the elderly and patients with less severe forms of disease, is not properly cared for. As diabetes centres are more likely to adhere to guidelines than GPs, quality in diabetes care process can be improved by increasing the intensity of disease management programmes, with greater participation by GPs.