Abstract
This study is part of the study to develop the monitoring system for primary
care at a macro level. This part shows the evaluation result of diabetic care
system of various contracting units for primary care in purposively sampled 18
CUPs, 4 regions. The components of the evaluation were diabetic care system
and process, clinical results, knowledge, practices and quality of life of diabetic
patients. The methodologies used were internal evaluation by questionnaires
and explore evaluation by observation, interview and documentary review. The
result showed that the quality of the systems among CUPs was much varied.
Most were passive, not proactive on risks and complications management. Primary
care showed fewer roles, only screening and follow up. Most of them were
not well supported by hospitals and CUPs. Health outcomes indicated that 38
percent of the total had good control of plasma glucose (HbA1c < 7 mg%); 10-19
percent high cholesterol, 21-43 percent high HDL, 2-12 percent high triglyceride
particularly among women than men; 31-50 percent micro-albuminurea (>30),
high creatinine 2-30 percent. These were different among areas and diabetes over
5 years had more complications than diabetes less than 5 years. The knowledge,
practice and quality of life of diabetes were varied among CUPs. Most had good
knowledge and practice on medication and general management, but has less
on diet, foot care and care for special events. Diabetes had quality of life on mental
aspect less than other aspects. Those with diabetes less than 5 years had
quality of life score on physical and dependency aspect better than those more
than 5 years, but the scores other aspects were not different. The diabetes in
areas that had better knowledge and practice also had higher score of quality of
life.
This study showed that the evaluation of diabetes care system can be one
tracer to monitor quality of primary care and contracting units of primary care.
The process and some outcome indicators in this study can be used to compare
conditions among areas.
This study is part of the study to develop the monitoring system for primary
care at a macro level. This part shows the evaluation result of diabetic care
system of various contracting units for primary care in purposively sampled 18
CUPs, 4 regions. The components of the evaluation were diabetic care system
and process, clinical results, knowledge, practices and quality of life of diabetic
patients. The methodologies used were internal evaluation by questionnaires
and explore evaluation by observation, interview and documentary review. The
result showed that the quality of the systems among CUPs was much varied.
Most were passive, not proactive on risks and complications management. Primary
care showed fewer roles, only screening and follow up. Most of them were
not well supported by hospitals and CUPs. Health outcomes indicated that 38
percent of the total had good control of plasma glucose (HbA1c < 7 mg%); 10-19
percent high cholesterol, 21-43 percent high HDL, 2-12 percent high triglyceride
particularly among women than men; 31-50 percent micro-albuminurea (>30),
high creatinine 2-30 percent. These were different among areas and diabetes over
5 years had more complications than diabetes less than 5 years. The knowledge,
practice and quality of life of diabetes were varied among CUPs. Most had good
knowledge and practice on medication and general management, but has less
on diet, foot care and care for special events. Diabetes had quality of life on mental
aspect less than other aspects. Those with diabetes less than 5 years had
quality of life score on physical and dependency aspect better than those more
than 5 years, but the scores other aspects were not different. The diabetes in
areas that had better knowledge and practice also had higher score of quality of
life.
This study showed that the evaluation of diabetes care system can be one
tracer to monitor quality of primary care and contracting units of primary care.
The process and some outcome indicators in this study can be used to compare
conditions among areas.
