Quality of diabetes care in primary care setting in egypt: an example of health sector reform in developing countries.

The aim of this study was to evaluate the extent of provider adherence to evidence-based guidelines for diabetes care and the extent of glycemic, blood pressure, and lipid control in patients with diabetes in a developing country. A retrospective cohort study was carried out to evaluate diabetes care provided under Health Sector Reform Program (HSRP) in a major medical center in Alexandria, Egypt. Data on care provided for 137 patients were abstracted from medical records. Several process measures were studied including annual proportion of patients with measurements of blood glucose, blood pressure, and lipid levels. Patient outcomes on these measures were also examined. Logistic and poisson regressions were used to study factors related to having measurements done and number of measurements respectively. Multilevel analysis was then used to examine rate of change in patient outcomes and factors associated with this rate over one year of follow-up. For 137 patients with diabetes, annual testing was adequate for fasting blood glucose (FBG) (94.1%), blood pressure (100%), foot (92.7%), and fundus examination (86.6%) was adequate. On the other hand less attention was given to total cholesterol (60.6%), triglycerides (52.6%) and albuminuria (10.3%). At the end of 1 year follow-up, 89.2% did not meet the target level of fasting blood glucose of < 130 mg/dl. A total of 40.2% and 46.7% did not meet the goal of 130 mmHg for systolic and 80 mmHg for diastolic blood pressure. Fifty nine percent, and 76.4% did not meet the goal of total cholesterol level of <200 mg/dl, or triglycerides level of <150 mg /dl respectively. There was evidence of suboptimal treatment with insulin, antihypertensive drugs, and lipid- lowering drugs. This study demonstrates that diabetes care provided under HSRP is unsatisfactory. As a result more effort to increase compliance with evidence based guidelines in diabetes care is needed.