Implementing quality indicators for diabetes and hypertension in family medicine in Slovenia

A new form of family practices was introduced in 2011 through a pilot project introducing nurse practitioners as members of team and determining a set of quality indicators. The aim of this article was to assess the quality of diabetes and hypertension management.We included all family medicine practices that were participating in the project in December 2015 (N=584). The following data were extracted from automatic electronic reports on quality indicators: gender and specialisation of the family physician, status (public servant/self-contracted), duration of participation in the project, region of Slovenia, the number of inhabitants covered by a family medicine practice, the name of IT provider, and levels of selected quality indicators.Out of 584 family medicine practices that were included in this project at the end of 2015, 568 (97.3%) had complete data and could be included in this analysis. The highest values were observed for structure quality indicator (list of diabetics) and the lowest for process and outcome quality indicators. The values of the selected quality indicators were independently associated with the duration of participation in the project, some regions of Slovenia where practices were located, and some IT providers of the practices.First, the analysis of data on quality indicators for diabetes and hypertension in this primary care project pointed out the problems which are currently preventing higher quality of chronic patient management at the primary health care level.Pilotni projekt na področju družinske medicine v Sloveniji je leta 2011 uvedel novo metodo dela v družinski medicini, pri čemer je nov član tima postala diplomirana medicinska sestra, prav tako pa se je uvedel nadzor kakovosti s pomočjo kazalnikov kakovosti. Namen tega članka je bil oceniti kakovost vodenja bolnikov s sladkorno boleznijo in hipertenzijo.V analizo smo vključili vse ambulante družinske medicine, ki so sodelovale v projektu konec decembra 2015. Iz avtomatične baze poročil smo izluščili in analizirali naslednje podatke: spol in specializacijo zdravnika, status zdravnika (javni uslužbenec, koncesionar), trajanje sodelovanja v projektu, regijo, v kateri je ambulanta, število prebivalcev na območju, ki ga pokriva ambulanta, računalniško hišo, ki nudi program, in raven izbranih kazalnikov kakovosti.Od 584 ambulant družinske medicine jih je imelo 568 (97,3%) popolne podatke in so bile vključene v analizo. Najvišja vrednost kazalnikov kakovosti je bila opazovana pri kazalnikih kakovosti pogojev (register diabetikov), najnižja pa pri kazalnikih procesa in izida. Vrednosti izbranih kazalnikov kakovosti so bile neodvisno povezane s trajanjem sodelovanja v projektu, nekaterimi regijami Slovenije in nekaterimi računalniškimi hišami, ki nudijo elektronsko podporo.Prva analiza podatkov kazalnikov kakovosti za diabetes in arterijsko hipertenzijo je pokazala na probleme, ki trenutno onemogočajo doseganje višje kakovosti obravnave bolnikov na primarni ravni zdravstvenega varstva.