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International Journal for Quality in Health Care Advance Access published online on April 14, 2005
International Journal for Quality in Health Care, doi:10.1093/intqhc/mzi043
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International Journal for Quality in Health Care Published by Oxford University Press on behalf of International Society for Quality in Health Care, 2005
Accepted March 6, 2005

Article

A controlled before-after trial of structured diabetes care in primary health centres in a newly developed country

Richard L. Reed 1*, Anthony D. Revel 2, Anne O. Carter 3, Hussein F. Saadi 4, and Earl V. Dunn 1

1 United Arab Emirates University, Family Medicine, Al Ain, Abu Dhabi, United Arab Emirates,
2 United Arab Emirates University, Family Medicine, Al Ain, Abu Dhabi, United Arab Emirates; Ministry of Health, Al Ain Medical District, Al Ain, Abu Dhabi, United Arab Emirates
3 United Arab Emirates University, Community Medicine, Al Ain, Abu Dhabi, United Arab Emirates,
4 United Arab Emirates University, Internal Medicine, Al Ain, Abu Dhabi, United Arab Emirates

* To whom correspondence should be addressed.
Richard L. Reed, E-mail: rreed{at}uaeu.ac.ae


  Abstract

Objective. To evaluate the long-term impact of a structured approach to improving the quality of diabetes care in general practice in the United Arab Emirates.

Design. Controlled before-after trial within a health district with three primary health centres (PHCs) in the intervention group and the six remaining serving as controls. Outcomes and adherence to guidelines were measured over the year before the intervention began and for a second 1-year period at the end of the intervention period. Data were collected by chart abstraction.

Setting. The study was performed in PHCs in the United Arab Emirates, a newly developed country on the Arabian peninsula.

Study participants. Subjects continuously followed in nine PHCs for diabetes care for the period of the study (N = 738) were included in the study.

Intervention. Structured diabetes care, including the development of general practice diabetes clinics, a patient education program, a health care professional education program, and improved recording of clinical education, was provided for the 33- month time period.

Results. There was a statistically significant improvement in three of the process of care variables (ordering HbA1c, cholesterol, and documenting foot examinations) whereas the four remaining variables did not improve. There was limited impact on outcome variables.

Conclusions. The intervention described in this study demonstrated an improvement in some process of care measures suggesting an impact of this type of delivery model in this environment.

Keywords: diabetes mellitus, physician practice pattern, practice guidelines, primary health care, therapy, treatment outcome.
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