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Identifier

000365633

Title

Αξιολόγηση μιας πιλοτικής παρέμβασης στην πρωτοβάθμια φροντίδα υγείας της Κύπρου για την βελτίωση της ποιότητας των παρεχόμενων υπηρεσιών

Alternative Title

Evaluation of a quality improvement intervention in primary care of Cyprus.

Author

Σαμούτης, Γεώργιος Α

Thesis advisor

Λιονής, Χρήστος

Reviewer

Κογεβίνας, Εμμανουήλ
Φιλαλήθης, Αναστάσιος
Κουρούμαλης, Ηλίας
Σιαφάκας, Νικόλαος
Χλουβεράκης, Γρηγόρης
Τζανάκης, Νικόλαος

Abstract

Background: The achievement of quality of care remains a priority for modern health care systems and a challenge for many western societies. The objective of our study was to evaluate the effectiveness of a multifaceted intervention to improve quality of care in diabetic hypertensive patients in the primary care of Cyprus. Methods/Design: All patients from two urban and two rural public primary care centers diagnosed concurrently with hypertension and type II diabetes mellitus were recruited in a community–based intervention. Main components of the intervention were the development and adoption of an electronic medical record, the setting up of a quality improvement team, and the introduction of clinical guidelines for the management of the targeted diseases. The primary outcome measurement was improvement in the quality of care for two chronic diseases as measured through specific clinical indicators. Patient satisfaction was also evaluated using the EUROPEP questionnaire. Results: Our analysis included 278 intervention and 226 control subjects. Physicians and nurses rated EMR relatively highly, while patients were the most enthusiastic supporters for the new information system. Major implementation impediments were the physicians’ perceptions that EMR usage negatively affected their workflow, physicians’ legal concerns, lack of incentives, system breakdowns, software design problems, transition difficulties and lack of familiarity with electronic equipment. Mean measurements as well as target levels for blood pressure, total cholesterol and LDL-C and three annual performance measures were significantly higher at follow up in the intervention as compared to the control group. The annual percentage of micro albumin/24-hour urine protein testing, the dilated eye examinations and the foot examinations increased from 0% to 37% (n=103), 59% (n = 164), and 73% (n= 202), respectively. Finally, the intervention was associated with a significant increase in satisfaction with the provided care as shown by the EUROPEP questionnaire. 14 Conclusion: A quality improvement multifaceted intervention tailored to local needs has the potential to improve the quality of primary care services for diabetic hypertensive patients. More efforts are needed for the universal adoption and routine use of EMR in the primary care system of Cyprus as several barriers to adoption exist; however, none is insurmountable. Future studies need to involve longer follow-up periods and broader patient population.

Language

Greek

Subject

Primary health care

Quality improvement intervention

Παράσιτα

Πιλοτική παρέμβαση

Πρωτοβάθμια φροντίδα υγείας

Issue date

2009-7-24

Collection

School/Department--School of Medicine--Department of Medicine--Doctoral theses