Five years of DiabCare-France: assessement and perspectives.

The Declaration of Saint Vincent was the starting point for the European Di abCare system. Five years of French experience with this system now provide an opportunity for critical assessment. Within the perspective of quality assurance, DiabCare is an efficient developmental tool which should eventua lly allow the divergence between real and ideal quality to be reduced. On t he basis of a European scientific reference system, each country uses its o wn funds to organise national campaigns with the assistance of pharmaceutic al firms. Each year a transverse collection of a month's data concerning al l hospitalised diabetic patients is done at the European level by means of a standardised form. Confidential and anonymous analysis of the data is the n performed by the scientific committee of DiabCare-France and the CERIM of Lille. Each participating physician receives a report specifying the situa tion for his group and providing anonymous comparisions with national data. This rich database offers each centre the possibility for a personalised a appraisal and retrospective evaluation of modifications in medical practic es. DiabCare is in fact of interest to a variety of persons and organisatio ns. For the patient, the DiabCare sheet and the forthcoming Diabcard (smart card) are means of providing guidance for the annual checkup. The general practitioner or specialist has indications about his patients' condition an d guidance for more rigourous management. Interestingly, DiabCare is the on ly evaluation programme approved by general practitioner unions. For the ho spital department, DiabCare provides-much more detailed information than PM SI, offering a department head useful arguments in support of specific budg et allocations and allowing the care team to consider its activity and dete rmine priorities. It is a useful and precise evaluation tool for hospitals in the perspective of future accreditation. For the national and internatio nal scientific community, it provides data which, though biased by voluntar y participation and non-epidemiological, are useful for analysis and compar ison of particular diabetological circumstances in the field. In this respe ct, it is noteworthy that the World Health Organisation (WHO), the Internat ional Diabetes Federation, and the CSD have supported this initiative. For WHO, care practices and payment systems differ considerably in European cou ntries, so that the existence of a common tool for collecting and evaluatin g data allows relevant procedures to he identified more quickly and communi cated and recommended to the different governments. Finally, in view of the human and economic burden caused by late complications of diabetes, societ y can benefit Any improvement in the control of risk factors and the object ive reduction of complications is important for survival of the health care system.