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The QUADRI Study...
The QUADRI Study
In 2004, the Istituto
Superiore di Sanità coordinated the epidemiological
study known as “QUADRI” (“Quality of Care for Diabetics in
Italian Regions”), with the objective of assessing the
quality and means of providing care, as perceived by persons
with diabetes.
Care for persons with diabetes
- A sample of 3,426 persons (58% men) were interviewed; the
median age was 57 years, and 41% of the sample had fewer
than 7 years of education.
- Of the participants, 30% suffered
from at least one complication, the most frequent of which
was diabetic retinopathy (19%), followed by ischemic heart
disease (13%). About 1 out of 5 participants had been
hospitalised in the year preceding the interview.
- Of the
participants, 54% were aware of having hypertension, yet 14%
of them were not undergoing therapy. Forty-four percent
reported high cholesterol, yet 26% were not undergoing
specific therapy.
- At the time of diagnosis, 34% of the
participants smoked; at the time of the interview, 25% still
smoked, despite the fact that nearly all of them had been
advised to quit.
- Of the participants, 72% were overweight;
82% of them had been advised to lose weight, yet only half
were attempting to do so (through diet, physical activity,
and pharmaceuticals).
- For most of the interviewed persons
(64%), the main provider of care was the diabetes centre.
The most common therapy was oral anti-diabetics alone (61%),
whereas 26% of the persons used insulin or insulin plus oral
anti-diabetics.
- Only 49% of the participants had undergone a
thorough examination by a general practitioner or a diabetes
specialist in the previous six months; 59% had undergone an
eye examination in the previous year, and 42% had received
the influenza vaccine.
- In the 4 months prior to the
interview, glycosylated hemoglobin had been performed for
66% of the persons who had heard of the test (67% of the
sample).
- Of the persons undergoing insulin treatment, 63%
performed self-monitoring of glycaemia at various times
during the day.
- Among the persons with a cardiovascular
risk, only 15% used acetylsalicylic acid as primary
prevention.
- Nearly all of the persons interviewed (91-92%)
were satisfied with the attitudes of healthcare workers.
- Regarding the overall organisation of services, more than
80% of the persons were satisfied.
Conclusions
Despite some limitations, this study has contributed to
increasing the knowledge on the various aspects of the care
provided to persons with diabetes. The results indicate that the
quality of the care provided is far from optimal. In Italy, as
in other Western countries, there has been an increasingly
heated debate over the ability of the healthcare system to
reorganise its model of healthcare in the foreseeable future, so
as to take into account the demand for care that is changing in
terms of both quantity and quality and thus to adapt the
facilities and services to the population’s true needs.
The need for integration and coordination in the management
of care has led to the development of new care models which, in
very general terms, can be defined as “disease management”.
These approaches share the characteristics of being organised,
integrated, proactive, and people-oriented, and at the centre of
the system is an informed patient who has been educated to play
an active role in managing his/her disease.
Download the
ISTISAN report (pdf 3 Mb) with the definitive results of the
study.
