Management of kidney disease in patients with diabetes in the primary care setting.

Aims: To evaluate the performance of general practitioners (GPs) in the care of diabetic patients in areas represented or unrepresented by quality indicators.

Methods: An observational study in primary care practices. The study population was comprised of GPs who cared for 1799 patients with diabetes mellitus co-existing with stage 3 chronic kidney disease, hypertension, and cardiovascular disease. The performance of GPs was monitored twice during a 6-month interval using a regional computerized clinical data base according to the measurement and treatment of blood pressure, LDL-cholesterol level, proteinuria, hematuria, and anemia.

Results: Those parameters which were familiar to the GPs for several years as part of the Quality Indicators Program (QIP) were measured and treated at a high rate compared to parameters not included in the QIP. For example, measurement of blood pressure and testing for glycosylated hemoglobin were 99% and 98% respectively at the end point. In contrast the rate of performance of specific kidney disease-focused activities, such as referral of patients with proteinuria to nephrologic consultation was 36% at the end point.

Conclusion: Good performance in areas monitored by Quality Indicators does not imply good quality of care in other areas for the same patients. Attention should be paid to initiating activities to raise the awareness of GPs with respect to important health parameters which are not included in the Quality Indicators Program.