Quality assessment of diabetes care according to the recommendations of the St. Vincent Declaration: A population-based study in a rural area of Austria.

Using a mobile ambulance the quality of diabetes care was evaluated, according to the recommendations of the St. Vincent Declaration, in 95 % of all known diabetic patients ( n = 395) in a geographically defined rural area of Austria with 7871 inhabitants. Fourteen of the 395 patients had Type 1 (insulin-dependent) diabetes with age at onset of diabetes below 30 years. Of the 375 patients examined (women 61%, age 66 ± 13 years, median diabetes duration 6 years) 16 % were treated with insulin and 47 % with oral agents; HbA levels were 7.3 ± 1.7 %. Prevalence of known hypertension was 54%; 68% of these patients had their blood pressure uncontrolled (systolic ≥ 160 and/or diastolic ≥ 95 mmHg); a further 15% of patients with previously unknown hypertension had blood pressure values of ≥ 160 and/or ≥ 95 mmHg. Urinary albumin concentrations of > 200 mg/l were found in 15% of patients, 2% had a serum creatinine level of > 177 μmol/l, no patient had renal replacement therapy. Six patients (1.5%) were blind. Screening for retinopathy identified six patients (out of 317 in whom the retina could be evaluated) for whom consultation with an ophthalmologist as soon as possible was recommended. Of the total patient group ( n = 395) 20 patients (5%) had foot complications (amputations and/or ulcers): 14 patients had a total of 21 lower limb amputations (eight above knee, six below knee, seven below ankle); eight of these 14 patients lived in a nursing home; 11 patients had a total of 13 foot ulcers. In conclusion, in this diabetic population quality of diabetes care was satisfactory with respect to glycaemic control, whereas the high rates of uncontrolled hypertension and above ankle amputations appear amenable to improvement. This study shows that through systematic assessment of the quality of diabetes care specific local needs and deficiencies can be identified in order to propose respective interventions in health care practices. [ABSTRACT FROM AUTHOR]