ABSTRACT
Introduction: This study aims to measure the quality of care for patients with diabetes mellitus at selected Specialist Outpatient Clinics (SOCs) in the National Healthcare Group. Materials and Methods: The cross-sectional study reviewed case-records of patients from 6 medical specialties who were on continuous care for a minimum of 15 months from October 2003 to April 2005. Disproportionate sampling of 60 patients from each specialty, excluding those co-managed by Diabetes Centres or primary care clinics for diabetes, was carried out. Information on demographic characteristics, process indicators and intermediate outcomes were collected and the adherence rate for each process indicator compared across specialties. Data analysis was carried out using SPSS version 13.0. Results: A total of 575 cases were studied. The average rate for 9 process indicators by specialty ranged from 47.8% to 70.0%, with blood pressure measurement consistently high across all specialties (98.4%). There was significant variation (P <0.001) in rates across the specialties for 8 process indicators; HbA1c, serum creatinine and lipid profile tests were over 75%, while the rest were below 50%. The mean HbA1c was 7.3% ± 1.5%. “Optimal” control of HbA1c was achieved in 51.2% of patients, while 50.6% of the patients achieved “optimal” low-density lipoprotein (LDL)-cholesterol control. However, 47.3% of patients had “poor” blood pressure control. Adherence to process indicators was not associated with good intermediate outcomes. Conclusions: There was large variance in the adherence rate of process and clinical outcome indicators across specialties, which could be improved further.
Singapore is a country with a high prevalence of diabetes mellitus, 1 8.2% amongst its population aged between 18 and 69 years,2 and is joint second in the world for “pre-diabetes” after Nauru. 3 About 17% of all patients admitted to 3 acute hospitals in the National Healthcare Group (NHG) have coexisting diabetes. The heavy burden of morbidity and mortality from macrovascular and microvascular complications makes it imperative that comprehensive and appropriate management of patients with diabetes should include early screening for complications.
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