Eerstelijnszorgmodel voor diabetes type 2: toepasbaar en haalbaar

Abstract

Meulepas MA, Braspenning JCC, Vlek JFM, Lucas AEM, De Grauw WJC, Grol RPTM. First-line care model for type 2 diabetes: applicable and feasible. Huisarts Wet 2006;49(7):356-60. Introduction The implementation of guidelines for diabetes care in general practice can be improved by several relevant elements: a patient register, an active recall system, a control system, feedback and quality improvement. We were unable to find a model integrating these five elements, and therefore constructed one around the triangle: general practitioner, practice nurse and diabetes support service. Background From all 1628 patients registered at 23 practices in the service district of the diabetes support service we checked whether they had been included in the model and, if not, why. We examined whether and how the 23 practices had integrated the five elements in their own protocols. Main quality measures The percentage of practices that delegated tasks according to the care model and the percentage of patients included in the model. Intervention The model was implemented in general practices by supporting tailor-made protocols in a standard manner. The practice nurses were prepared for the task during their training. Effects All five elements were seen to have been implemented systematically, except the monitoring of quality improvement. Of all known diabetic patients, 80% were treated in general practice. Of these patients, 97% were included in the model (selected by the general practitioner and accepted by the patient). In 70% of the practices the practice nurse carried out not only the quarterly controls but also the annual control. Of all patients seen by the practice nurse, 93% kept all appointments. Lessons learned and follow up The diabetes care model is well applicable. The general practitioner delegates tasks to the practice nurse and to the diabetes support service. The fact that monitoring quality improvement has not yet been implemented in every general practice is in all likelihood related to a stepwise implementation of the five elements. It seems to be merely a matter of time before all the elements have been integrated. The inclusion percentage in the control system was far higher than we found in other studies.