Quality of medical care for patients with arterial hypertension and type 2 diabetes mellitus in outpatient medical organizations

BACKGROUND: The course of arterial hypertension and diabetes mellitus depends on the medical care quality since its poor provision increases the risk of unfavorable outcomes. Identifying and analysing defects in the management of such patients is an urgent task. AIM: To assess the medical care quality provided to patients with hypertension and type 2 diabetes mellitus on an outpatient medical organizations. MATERIALS AND METHODS: The assessment of the medical care for patients with hypertension and type 2 diabetes mellitus in outpatient medical organizations in St. Petersburg and the Leningrad region was carried out by analyzing primary medical records for 175 cases. RESULTS: The quality of medical care is recognized as appropriate only in 25% of the cases. The errors in collecting information were the most common (95% of the cases of poor quality medical care): in cases of hypertension and type 2 diabetes mellitus no information about the course of the disease, previous treatment, risk factors, anthropometry, ophthalmoscopy or referral to an ophthalmologist; neurological examination and assessing cognitive functions - in the patients with hypertension; foot examination – in the patients with diabetes. The most common defects of the examination included the absence of lipidogram, uric measurement and electrolyte levels in hypertension, determination of albuminuria in diabetes mellitus, electrocardiography and echocardiography. Diagnosis errors were detected in 7–15% of the cases, treatment defects — in 33–53%. The information collection error is the most common defect in case of the patients with hypertension and type 2 diabetes mellitus, which is comparable with the previously published data. Treatment errors mainly consisted in the absence of lifestyle modification recommendations necessary for the treatment of hypertension and type 2 diabetes mellitus since these measures reduce the risk of complications and improve the prognosis.The revealed defects in medication therapy were comparable to the previous data and consisted in the appointment of insufficient doses of medications and in the use of monotherapy in the presence of indications for combination therapy. CONCLUSIONS: The assessment of the medical care revealed an insufficiently high level of outpatient medical care for the patients with hypertension and type 2 diabetes mellitus, which requires a detailed analysis of the causes for future prevention.