Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)
Quality of Diabetes Care: The Challenges of an Increasing Epidemic in Mexico. Results from Two National Health Surveys (2006 and 2012)
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DOI：
10.1371/journal.pone.0133958
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发表时间：
2015-07-31
期刊：
影响因子：
3.7
通讯作者：
Hernandez-Avila, Mauricio
中科院分区：
文献类型：
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作者：
Flores-Hernandez, Sergio;Saturno-Hernandez, Pedro J.;Hernandez-Avila, Mauricio
背景糖尿病护理的质量仍然是次优的，根据大量的研究评估各种医疗机构的糖尿病护理质量指标的实现。我们报告有关全球和具体的质量指标糖尿病护理及其关联的血糖控制在人口水平上的两个国家的健康调查在Mexico.MethodsWe进行了横断面分析，2006年和2012年的全国健康调查在墨西哥。我们使用来自自我报告信息的14个简单指标和2个复合指标，检查了2，965和4，483名确诊为2型糖尿病的成年人（≥ 20岁）的护理质量。在两项调查的子样本中，在访谈时测量糖化血红蛋白（HbA 1c）。我们获得了调查权重调整估计使用多元回归模型（逻辑和线性）与组合的数据文件，包括调查年作为协变量，以评估change.ResultsGlobal的护理质量在2012年为40.8%，2006年和2012年之间的相对改善11.7%。心血管疾病危险因素（血脂异常和高血压）的检测是改善最大的指标，而非药物治疗和糖尿病足检查显示出微小的变化。我们发现糖尿病护理过程的质量与血糖控制之间存在显著相关性（OR 2.53，95%CI 1.63-3.94）。年龄超过65岁，健康子系统的类型，性别（男性），高社会经济地位也显着相关血糖control.ConclusionsQuality糖尿病护理和血糖控制改善，显着相关。然而，根据国际标准，目前的情况仍然不理想。需要采取更全面的方法，重点是提高门诊护理质量。
BackgroundThe quality of diabetes care remains suboptimal according to numerous studies assessing the achievement of quality indicators for diabetes care in various healthcare settings. We report about global and specific quality indicators for diabetes care and their association to glycemic control at the population level in two national health surveys in Mexico.MethodsWe conducted a cross-sectional analysis of the 2006 and 2012 National Health Surveys in Mexico. We examined quality of care for 2,965 and 4,483 adults (>= 20 years) with diagnosed type 2 diabetes using fourteen simple and two composite indicators derived from self-reported information. In a subsample for both surveys, glycated hemoglobin (HbA1c) was measured at the time of the interview. We obtained survey weight-adjusted estimators using multiple regression models (logistic and linear) with combined data files, including survey year as covariate to assess change.ResultsGlobal quality of care in 2012 was 40.8%, with a relative improvement of 11.7% between 2006 and 2012. Detections of cardiovascular disease risk factors (dyslipidemia and hypertension) were the indicators with the highest improvement, while non-pharmaceutical treatment and diabetic foot exams showed minor changes. We found a significant association between the quality of the process of diabetes care and glycemic control (OR 2.53, 95% CI 1.63-3.94). Age more than 65 years old, the type of health subsystem, gender (males), and high socio-economic status were also significantly associated to glycemic control.ConclusionsQuality diabetes care and glycemic control improved and are significantly associated. However, according to international standards, the current situation remains suboptimal. A more holistic approach is needed, with an emphasis on improving quality in outpatient care.