Analysis of Changes of Diabetes Care Quality under Implementation of Unified Clinical Pathway for Caring Diabetic Type 2 Patients

• Main Author: V.I. Tkachenko
• Format: Article
• Language: English
• Published: Publishing House Zaslavsky 2015-03-01
• Series: Mìžnarodnij Endokrinologìčnij Žurnal
• Subjects: type 2 diabetes mellitus; quality of care; clinical pathway implementation; optimization
• Online Access: http://iej.zaslavsky.com.ua/article/view/75452
• ISSN: 2224-0721; 2307-1427

After the adoption of a unified clinical pathway for diabetes mellitus type 2 care in 2012 in Ukraine it is relevant to analyze the results of its implementation and the quality of diabetes care. The aim is to analyze the quality of diabetes care and results of implementation of unified clinical pathway for caring diabetic type 2 patients in Ukraine and Kyiv region for 2003–2012–2014 years (Order of MH of Ukraine № 1118, d/d December, 21, 2012). Materials and methods. We developed a methodology that includes monitoring quality indicators, statistical analysis of reports of medical establishments, that were complemented by survey of 543 doctors and 92 patients with type 2 diabetes mellitus and analysis of outpatient records. Results. The quality of diabetes care on the early stages of pathway implementation is improper. The recommended annual monitoring is incomplete. It does not cover all recommended parameters and all patients. In addition, insufficient preventive measures are used and not all patients achieve target levels as a result. This led to increasing hospitalizations and reducing primary diseases incidence caused by both a lack of physicians commitment and a lack of patients adherence to treatment and the impact of socio-economic aspects of life in Ukraine nowadays. Our data are similar to European experience in implementation of a clinical pathway for diabetes mellitus care. Due to the growing prevalence and incidence of type 2 diabetes mellitus, the burden on endocrinologists continues to increase. In order to optimize the quality of diabetes mellitus care it is necessary to ensure the availability of laboratory tests and more active involvement of general practitioners. For this purpose we have developed and implemented a typical local protocol, form of monitoring the quality of diabetes mellitus care, conducted the additional educational activities (lectures, seminars, workshops, thematic improvement cycles) for physicians, nurses and patients. Conclusions. The quality of diabetes mellitus care on the early stage is insufficient. Introduced measures optimizing the quality of diabetes mellitus care in the Kyiv region had positive results.