Factors affecting the quality of diabetes care in primary health care centres in Tunis.

We have conducted a retrospective medical record review of a random sample of 580 patients with diabetes from 12 primary health care centres (PHCCs) in Greater Tunis. The aim was to assess the quality of diabetes care in PHCCs and to explore factors associated with quality of care. Data were collected concerning patient characteristics, health centre characteristics and process of care criteria. In our sample, recording of care varied significantly between the health centres for all of the process of care criteria studied. Factors significantly associated with improved recording of care were younger patient age (found in 5 of the 10 process of care criteria), use of the new medical records (8 of the 10 criteria), urban health centres (8 of the 10 criteria) and those centres with a doctor with a special interest in diabetes (7 of the 10 criteria). Gender and socio-economic status were not found to be associated with recording of care. The quality of diabetes care in Greater Tunis varies widely between PHCCs and a number of associated factors have been highlighted. A fuller understanding of quality of care within the context of the patients' environment is essential in order to develop appropriate health interventions.