Adherence to diabetes care processes at general practices in the National Capital Region-Delhi, India

Abstract

Aim: To assess the level of adherence to diabetes care processes and associated clinic and patient factors at general practices in Delhi, India. Methods: We interviewed physicians (n = 23) and patients with diabetes (n = 406) and reviewed patient charts at general practices (government = 5; private = 18). We examined diabetes care processes, specifically measurement of weight, Blood Pressure (BP), glycated hemoglobin (HbA1c), lipids, electrocardiogram, dilated eye and a foot examination in the last one year. We analyzed clinic and patient factors associated with a number of care processes achieved using multilevel Poisson regression model. Results: The average number of clinic visits per patient was 8.8/year (standard deviation = 5.7) and physicians had access to patient's previous records in only 19.7% of patients. Dilated eye exam, foot exam and electrocardiogram were completed in 7.4%, 15.1% and 29.1% of patients, respectively. An estimated 51.7%, 88.4% and 28.1% had ≥1 measurement of HbA1c, BP and lipids, respectively. Private clinics, physician access to patient's previous records, use of nonphysicians, patient education and the presence of diabetes complication were positively associated with a number of care processes in the multivariable model. Conclusion: Adherence to diabetes care processes was suboptimal. Encouraging implementation of quality improvement strategies like Chronic Care Model elements at general practices may improve diabetes care.