Assessing variability in compliance with recommendations given by the International Diabetes Federation (IDF) for patients with type 2 diabetes in primary care using electronic records. The APNA study.

OBJECTIVE: Assess compliance with the IDF recommendations for patients with Diabetes Type2 (DM2), and its variability, by groups of doctors and nurses who provide primary care services in Navarre (Spain). MATERIALS AND METHODOLOGIES: A cross-sectional study of a population of 462,568 inhabitants, aged ≥18 years in 2013, attended by 381 units of doctor/nurse (quota). Clinical data were collected retrospectively through electronic records. Using cluster analysis, we identified two groups of units according to the score for each indicator. We calculated the Odds Ratio, adjusted for age sex, BMI, socioeconomic status and smoking, for complying with each recommendation whether a patient was treated by one of the quota from the highest score to the lowest. 30,312 patients with DM2 were identified: prevalence: 6.39%; coefficient of variation between UDN: 22.8%; biggest cluster 7.7% and smallest 5.3%; OR=1.54 (1.50-1.58). The HbA1c control at ≤8% was 82.8% (82.2-83.3) and >9% was 7.6% (7.3-8.0), with OR 1.79 (1.69-1.89) and 2.62 (2.36-2.91) respectively. Control of BP and LDL-C show significant differences between the clusters. CONCLUSIONS: An important variability was identified according to the doctor treating patients. The average HbA1c control is acceptable being limited in BP and LDL-C.

[Selection of quality indicators for primary care prescription through a consensus group]. / Selección de indicadores de calidad de prescripción en atención primaria mediante un grupo de consenso.

OBJECTIVE: To work out a system of indicators for improvement of primary care prescription, by incorporating the values and views of the professionals issuing prescriptions. DESIGN: Qualitative technique to search for consensus among experts, based on nominal groups. SETTING: All primary care areas in the Health Service of Aragon, Spain. PARTICIPANTS: Primary care doctors, doctors in primary care management teams, specialists, primary care pharmacists. METHOD: Two parallel groups involving a total of 24 experts were formed. In the session these questions were posed: "what indicators focusing on the drug and what indicators relating diagnosis and treatment do you think most useful for evaluating prescription quality?" Each panellist put forward indicators that were then discussed and placed on a scale of 1 to 9. RESULTS: One hundred and thirty six indicators were generated, 81 drug-focused and 55 relating diagnosis and treatment; 56% were given a weighting above 5. The 2 groups coincided in 11 cases. The most valued indicators were generally those that brought a greater degree of consensus. CONCLUSION: It is feasible, through this technique, to produce a set of agreed indicators for evaluating primary care doctors' prescription.

Selección de indicadores de calidad de prescripción en atención primaria mediante un grupo de consenso / Selection of quality indicators for primary care prescription through a consensus group

Objetivo. Elaborar un sistema de indicadores que permita mejorar la evaluación de la prescripción en atención primaria, incorporando los valores y la opinión de los profesionales implicados en la prescripción. Diseño. Técnica cualitativa de búsqueda de consenso entre expertos basada en el grupo nominal. Emplazamiento. Todas las áreas de atención primaria del Servicio Aragonés de Salud. Participantes. Médicos de atención primaria, médicos del equipo directivo de atención primaria, médicos de atención especializada, farmacéuticos de atención primaria. Método. Se forman dos grupos paralelos en los que en total participaron 24 expertos. En la sesión se planteó la pregunta: «¿Qué indicadores centrados en el fármaco y qué indicadores que relacionen diagnóstico y tratamiento consideras más útiles para evaluar la calidad de la prescripción?» Cada panelista propuso indicadores que se discutieron y ponderaron en una escala de 1 a 9. Resultados. Se generaron 136 indicadores, 81 centrados en el fármaco y 55 que relacionan diagnóstico y tratamiento. El 56% obtuvo una ponderación mayor que 5. Ambos grupos coincidieron en 11. Los indicadores más valorados en general fueron los que suscitaron un mayor grado de consenso. Conclusión. Mediante esta técnica es factible producir un conjunto de indicadores consensuados para la evaluación de la prescripción de los médicos de atención primaria

Objective. To work out a system of indicators for improvement of primary care prescription, by incorporating the values and views of the professionals issuing prescriptions. Design. Qualitative technique to search for consensus among experts, based on nominal groups. Setting. All primary care areas in the Health Service of Aragon, Spain. Participants. Primary care doctors, doctors in primary care management teams, specialists, primary care pharmacists. Method. Two parallel groups involving a total of 24 experts were formed. In the session these questions were posed: "what indicators focusing on the drug and what indicators relating diagnosis and treatment do you think most useful for evaluating prescription quality?" Each panellist put forward indicators that were then discussed and placed on a scale of 1 to 9. Results. One hundred and thirty six indicators were generated, 81 drug-focused and 55 relating diagnosis and treatment; 56% were given a weighting above 5. The 2 groups coincided in 11 cases. The most valued indicators were generally those that brought a greater degree of consensus. Conclusion. It is feasible, through this technique, to produce a set of agreed indicators for evaluating primary care doctors' prescription