ABSTRACT
BACKGROUND: Published data on quality of care indicators from various countries indicate the challenges of providing high-quality diabetes care. The objective of this study was to evaluate the quality of care provided to members of the Canadian Forces (CF) who have diabetes, by determining the extent to which healthcare providers adhere to recommendations outlined in the 2008 Canadian Diabetes Association (CDA) clinical practice guidelines. METHODS: All 14 CF bases meeting eligibility criteria were included in the evaluation. Cases of diabetes were ascertained based on laboratory criteria. Adherence to 21 CDA guideline recommendations was evaluated following a review of patient medical records. RESULTS: The CF demonstrated high adherence (>75%) with 9 recommendations, moderate adherence (50% to 75%) with 7 recommendations and low adherence (<50%) with 5 recommendations. Most notably, there were 4 recommendations for which adherence was greater than 90%. The mean rate of adherence with all applicable recommendations per patient was 60.3% (95% Confidence Interval [CI], 59.0% to 61.6%). CF adherence rates were generally similar to or better than comparable rates in the civilian population within Canada and other industrialized countries. CONCLUSIONS: It is unclear what accounts for the favourable quality of diabetes care in the CF Health Services, but this highly structured practice setting has a number of features that distinguish it from provincial healthcare systems. Several strategies can be considered to improve diabetes care even further, including providing feedback to physicians about their performance, promoting the use of diabetes care flow sheets and creating a diabetes registry.
Subject(s)
Diabetes Mellitus/therapy , Guideline Adherence/statistics & numerical data , Adult , Canada , Female , Humans , Male , Middle Aged , Military Personnel , Practice Guidelines as Topic , Quality of Health Care , Retrospective StudiesSubject(s)
Anthrax/diagnosis , Bioterrorism , Respiratory Tract Infections/diagnosis , Anthrax/diagnostic imaging , Humans , Mediastinum/diagnostic imaging , Pleural Effusion/diagnosis , Pleural Effusion/etiology , Pneumonia/diagnosis , Pneumonia/diagnostic imaging , Radiography , Respiratory Tract Infections/diagnostic imagingABSTRACT
OBJECTIVE: The objective of this study was to determine whether anthrax vaccine resulted in adverse health effects in Canadian Forces members 8 months after vaccination. METHODS: A quasi-experimental, retrospective chart review was undertaken for two groups within the Canadian Forces, one group that received anthrax vaccination and another that did not. Information on symptoms, diagnoses, and injuries for 848 persons for which there were approximately 35,000 chart entries was abstracted from charts over a 4.5-year period and was coded using the International Statistical Classification of Diseases and Related Health Problems, 10th edition. RESULTS: The chart retrieval rate was 84%. The mean number of chart entries per person was higher in the comparison group (43.4) than in the vaccine group (38.2). No statistically significant differences were seen in the percent change before and after vaccination in the number of chart entries for specific diagnoses and symptoms for the vaccine group compared with the comparison group. Visual inspection of the time trend in rates showed no unexplained increases in the rate of diagnosis and symptoms in the vaccine group after vaccination. CONCLUSION: This study found no evidence that the anthrax vaccination resulted in an increase in adverse health effects in the 8-month period after vaccination.
