OBJECTIVE: To measure the effective coverage of a program to control type 2 diabetes. DESIGN: Observational study combining multiple SETTING: Hidalgo state, Mexico. PARTICIPANTS: Adults without social security health benefits and patients with a diagnosis of diabetes participating in the program. MAIN OUTCOME MEASURES: Detection of diabetes; glucose, cholesterol, triglyceride and blood pressure control; education; diabetic retinopathy, diabetic foot and nephropathy prevention. RESULTS: Only 7.1% of individuals with diabetes participated in the control program. Fasting glucose and HbA1c values were available for 95.6 and 35.6 of patients, respectively. There were measurements of total cholesterol (52.1%), triglyceride (50.6%) and blood pressure (99.6%). Educative activities were realized for 64.8% of patients. The most important gaps were related with detection of illness, low-density lipoprotein cholesterol control, glucose control with HbA1c and nephropathy prevention. Effective coverage of these medical actions was 6.22, 5.07, 5.01 and 0.34%, respectively. CONCLUSIONS: The greatest challenge to overcome is the detection of individuals with illness because a large number of individuals with type 2 diabetes do not use health services and the health system does not systematically search them out. Medical actions that require resources that must be paid for by patients tend to be used less and to be of lower quality. The use of effective coverage to measure the performance of diabetes care program provides practical information to improve health services.
OBJECTIVE: To measure the effective coverage of a program to control type 2 diabetes. DESIGN: Observational study combining multiple SETTING: Hidalgo state, Mexico. PARTICIPANTS: Adults without social security health benefits and patients with a diagnosis of diabetes participating in the program. MAIN OUTCOME MEASURES: Detection of diabetes; glucose, cholesterol, triglyceride and blood pressure control; education; diabetic retinopathy, diabetic foot and nephropathy prevention. RESULTS: Only 7.1% of individuals with diabetes participated in the control program. Fasting glucose and HbA1c values were available for 95.6 and 35.6 of patients, respectively. There were measurements of total cholesterol (52.1%), triglyceride (50.6%) and blood pressure (99.6%). Educative activities were realized for 64.8% of patients. The most important gaps were related with detection of illness, low-density lipoprotein cholesterol control, glucose control with HbA1c and nephropathy prevention. Effective coverage of these medical actions was 6.22, 5.07, 5.01 and 0.34%, respectively. CONCLUSIONS: The greatest challenge to overcome is the detection of individuals with illness because a large number of individuals with type 2 diabetes do not use health services and the health system does not systematically search them out. Medical actions that require resources that must be paid for by patients tend to be used less and to be of lower quality. The use of effective coverage to measure the performance of diabetes care program provides practical information to improve health services.
Authors: Mahdi Mahdavi; Jan Vissers; Sylvia Elkhuizen; Mattees van Dijk; Antero Vanhala; Eleftheria Karampli; Raquel Faubel; Paul Forte; Elena Coroian; Joris van de Klundert Journal: PLoS One Date: 2018-02-15 Impact factor: 3.240