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ORIGINAL ARTICLE
Year : 2016  |  Volume : 20  |  Issue : 3  |  Page : 329-336

Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India


1 Centre of Chronic Conditions and Injuries, Public Health Foundation of India; Centre for Control of Chronic Conditions(4C), New Delhi, India
2 Emory Global Diabetes Research Center, Rollins School of Public Health, Emory University, Atlanta, GA, USA; Centre for Control of Chronic Conditions(4C), New Delhi, India
3 Department of Endocrinology and Metabolism, All India Institute of Medical Sciences; Centre for Control of Chronic Conditions(4C), New Delhi, India

Correspondence Address:
Roopa Shivashankar
Centre for Chronic Conditions and Injuries, Public Health Foundation of India, Plot No 47, Sector 44, Gurgaon - 122 002, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-8210.180000

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Aim: To assess the level of adherence to diabetes care processes, and associated clinic and patient factors at general practices in Delhi, India. Methods: We interviewed physicians (n = 23) and patients with diabetes (n = 406), and reviewed patient charts at general practices (government = 5; private = 18). We examined diabetes care processes, specifically measurement of weight, blood pressure (BP), glycated hemoglobin (HbA1c), lipids, electrocardiogram, dilated eye, and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model. Results: The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7), and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam, and electrocardiogram were completed in 7.4%, 15.1%, and 29.1% of patients, respectively. An estimated 51.7%, 88.4%, and 28.1% had ≥1 measurement of HbA1c, BP, and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education, and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model. Conclusion: Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.


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