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      [Care of patients with type 2 diabetes mellitus in primary care].

      Nederlands tijdschrift voor geneeskunde
      Delivery of Health Care, methods, standards, Diabetes Mellitus, Type 2, therapy, Ethnic Groups, Humans, Netherlands, Physician's Practice Patterns, Primary Health Care, Quality of Health Care, Socioeconomic Factors

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          Abstract

          Over the past 20 years, delivery ofdiabetes care in the Netherlands has shifted from secondary to primary care. Currently over 75% of all patients with type 2 diabetes mellitus are being treated by a diabetes team in general practice. Since 2000 both national and international publications have been describing the organisation and quality of primary diabetes care in the Netherlands. Apart from 4 large-scale diabetes projects in the areas of Zwolle, Hoorn, Maastricht and Breda, primary diabetes care is organised in various ways. At the end of 2005 a questionnaire sent to a representative group of 1621 general practitioners revealed that 95% kept a computerised diabetes register, one out of three practices delegated tasks to a diabetes service, and 20% of the practices had a shared care protocol with specialists. 2 out of 3 practices ran a diabetes clinic in which 2 out of 3 a practice nurse was involved. The results of 9 projects are known. 3 projects concern cross-sectional findings of disease management organisations, 6 concern general practices which were not participating in a diabetes project at the time of measurement, and 2 are clinical trials. Most of these measurements yielded representative data. They show that mean HbA(1C) levels < 7%, mean systolic blood pressure of about 143 mmHg, and mean cholesterol levels of about 4.5 mmol/l are achievable. With logistic support, regular check-ups of fundus and feet are achieved in 9 out of 10 patients. No special organisational model has proved to be superior. A correct assessment of quality of care indicators should take into account the heterogeneity of type 2 diabetes mellitus, as well as the socio-economic status and the ethnicity of the patient population.

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