The relationship between primary health care organization and quality of diabetes care.

Background: Despite many quality improvement trials, diabetes care often remains suboptimal. Few studies in a primary care setting have investigated the 'real life' association between organizational differences and quality of diabetes care.

Methods: Observational study among ten health care centres with a total of 45 general practitioners (GP). We investigated health care organization and related this to quality of care in a total of 1849 electronic patient records.

Results: There were large differences among health care centres in the percentage of patients receiving optimal care (range: 8-67%). The odds to receive good quality of care was higher if the health care centre had a diabetes education program (OR: 4.3; CI: 3.4-5.4), when yearly medical check-ups were done by both the GP and nurse practitioner (NP) (OR: 5.5; CI: 4.2-7.3), planned that after the patient visited the NP the patient is discussed with the GP (OR: 1.8; CI: 1.6-2.0), and had structured follow-up measures for compliance to check-ups (OR: 0.7; CI: 0.5-0.9 and OR: 0.59; CI: 0.5-0.7 for respectively one and two active measures compared to three active measures).

Conclusion: Also in real life, quality of care for type 2 diabetic patients is related to health care organization.