IS THE QUALITY OF DIABETES CARE BETTER IN A DIABETES CLINIC OR IN A GENERAL MEDICINE CLINIC

OBJECTIVE - To compare the quality of ambulatory diabetes care deliver ed by physicians in the diabetes clinic versus the general medicine cl inic of a university-affiliated Veterans Administration medical center . RESEARCH DESIGN AND METHODS - This is a retrospective study that inv olved the review of medical records against predetermined process-of-c are criteria. A total of 112 patients with diabetes were randomly sele cted, of whom 56 were cared for in the general medicine clinic and 56 in the diabetes clinic. The following main outcome measures were exami ned: 1) the compliance with individual criteria; and 2) the proportion of patient visits in each clinic receiving minimally acceptable quali ty, defined as a blood pressure measurement, a record of type of hypog lycemic medication, a glycated hemoglobin measurement within the past year, a urinalysis within the past year, an ophthalmologist or optomet rist eye examination within the past year or scheduled in the next six months, a record of change in therapeutic management, and a scheduled return visit. RESULTS - The diabetes clinic performed significantly b etter than the general medicine clinic on the following criteria: a re cord of a patient's self-monitoring of blood glucose levels; a foot ex amination; a comprehensive eye examination; a glycated hemoglobin meas urement; and a referral for diabetic education. The proportion of pati ent visits meeting the minimally acceptable levels of quality was bett er in the diabetes clinic than the general medicine clinic (73 vs. 52% , P = 0.02). CONCLUSIONS - Patients cared for by physicians in the dia betes clinic receive better quality of diabetes care than do patients cared for by physicians in the general medical clinic. If patient care is to be shifted from specialists to generalists, additional attentio n needs to be paid to ensure that generalists have the knowledge and s ystem resources necessary to deliver an acceptable quality of diabetes care.