Quality indicators of type 2 diabetes management in Greek primary care: A Delphi study

Philippe-Richard Domeyer, Vasiliki Katsari, Maria Psatha, Ana Cebrian, Gerardo Medea, Maria Drakou, Viktoria Katsouri, Niki Mourouti, Adamantios Mpourdakis, Evangelos Fragkoulis, Kyriakos Souliotis, Xavier Cos, Manel Mata-Cases

Keywords: Quality indicators; type 2 diabetes; primary care; Delphi

Background:
Type 2 diabetes mellitus is a worldwide cause of significant morbidity and mortality. However there is paucity of evidence regarding the quality of care delivered in Greece and a complete absence of quality indicators of type 2 diabetes in the Greek primary care.

Research questions:
This study aimed to develop a set of quality indicators to facilitate quality measurement of type 2 diabetes management in the Greek primary care.

Method:
A set of 43 preliminary quality indicators were identified through literature review and were sent to a 10 member Delphi panel, consisting of 3 Greek, 1 Italian and 1 Spanish General Practitioners (GPs), 1 Diabetologist, 1 Dietologist, 1 Professor of Health Politics and 2 patients with type 2 diabetes. The indicators were rated based on importance and feasibility during three rounds. The agreement criteria were defined as median ≥ 7.0 and ≥ 85.0% of ratings in the 7–9 tertile for importance; median ≥ 7.0 and ≥ 65.0, 70.0, 75.0% of ratings in the 7–9 tertile for feasibility respectively in the three rounds of rating.

Results:
A total of 39 indicators achieved consensus for inclusion in the final set of indicators, The final set of indicators were grouped into 10 domains: access (2 indicators), monitoring (13 indicators), health counseling (3 indicators), treatment (1 indicator), vaccination (1 indicator), patient safety (3 indicators), records (1 indicator), health status (11 indicators), patient satisfaction (2 indicators) and self-management (2 indicators).

Conclusions:
Our study presents for the first time a set of 39 quality indicators for type 2 diabetes in the Greek primary care that were assessed through an iterative Delphi process and judged as both important and feasible to implement.

Points for discussion:
Further testing and validation in Primary Care settings

Implementation in other south-european countries