Management of Type-2-Diabetes patients at Family Medicine Practices at the Community Health Centre Ljubljana (Slovenia): A Protocol of a Cross-Sectional Study

Črt Zavrnik, Matic Mihevc, Tina Virtič, Majda Mori Lukančič, Zalika Klemenc Ketiš, Antonija Poplas Susič

Keywords: type-2-diabetes, primary health care, bottlenecks, study protocol

Type-2-diabetes (T2D) is a major public health problem worldwide. In 2011, family medicine model practices were established in Slovenia to improve T2D care at the primary level with standardized clinical protocols. There is an urgent need to identify the bottlenecks of current T2D care in the family medicine practices in order to improve them for the future.

Research questions:
The aim of this study is to develop a research protocol to assess the current management of T2D patients in family medicine practices at the Community Health Centre Ljubljana (CHCL).

A cross-sectional study will be conducted. Individual clinical and demographic data will be collected from clinical protocols of patients with T2D treated in the CHCL family medicine practices in 2019. Descriptive statistics and multivariate logistic regression analyzes will then be performed to assess various aspects (parameters) of T2D care.

Data from a total of 5279 patient visits will be analyzed. (1) The process of care will be assessed by evaluating the ratio of performed T2D-specific visits, HbA1c measurement, screening for T2D complications (retinopathy, peripheral neuropathy, nephropathy), and screening for T2D comorbidities (hypercholesterolemia, arterial hypertension, metabolic syndrome). (2) Treatment outcomes will be evaluated by assessing the ratio of HbA1c, fasting glucose, LDL, and blood pressure levels in the target ranges. (3) The aforementioned variables will also be stratified by patient lifestyle (e.g., BMI, smoking, physical activity, and alcohol consumption) and sociodemographic factors (age, sex, education, employment, and subjective assessment of financial status).

The proposed research protocol will provide evidence of bottlenecks in current T2D care in family medicine practices in CHCL and identify potential opportunities for future expansion. It will also provide evidence on the influence of patient lifestyle and sociodemographic factors on T2D care and outcomes.

Points for discussion:
What will we learn from such a study?

What other evaluation strategies could be used to obtain a comprehensive assessment of T2D care in primary care?

What actions could be taken to address identified barriers?