The relationship between quality of care and self-management in patients with type 2 diabetes: a cross-sectional survey in primary care in Mexico.

Abstract

Background: Achieving glycaemic control in diabetes reduces complications and improves outcomes. Glycaemic control requires both good quality clinical care and effective self-management support. However, the relationship between these factors in routine clinical practice is unclear.

Aims: To evaluate baseline levels of self-management and clinical quality of care in patients with type 2 diabetes in primary care in Mexico and to explore relationships between measures of self-management and clinical quality of care.

Methods: The sample consisted of adults (N=205) diagnosed with type 2 diabetes for over a year and registered at one of five practices in the Mexican Institute of Social Security in Aguascalientes. Self-management and quality of care were measured using medical record review and interviews, including validated measures of diabetes knowledge, self-care behaviours, self-efficacy, treatment intensification, continuity of care, doctor-patient communication, and patient satisfaction with diabetes care. HbA1c and cholesterol tests were taken.

Results: There were few associations between measures of self-management, and between measures of the quality of clinical care. 'Strong' knowledge about medical prescription was associated with higher diabetes knowledge (OR = 1.2, 95% CI 1.08 to 1.32). Diabetes self-efficacy was associated with self-care behaviours (OR = 1.51, 95% CI 1.26 to 1.81). Patient-doctor communication was associated with continuity of care (Chi-squared = 11.03, P <0.05), with patient satisfaction (β = 6.17, 95% CI 4.47 to 7.93) and with diabetes self-efficacy (β = 0.70, 95% CI 0.19 to 1.20, P <0.01). Patient satisfaction was associated with continuity of care (F = 7.82, P <0.001).

Conclusion: The associations between measures of self-management and quality of care were modest. Patients who were achieving high levels of one aspect of care were not necessarily receiving high levels of the other. This indicates that different factors are likely to be driving each aspect of care and highlights the importance of measuring their relative importance.