A controlled before–after trial of structured diabetes care in primary health centres in a newly developed country

Objective. To evaluate the long-term impact of a structured approach to improving the quality of diabetes care in general practice in the United Arab Emirates. Design. Controlled before–after trial within a health district with three primary health centres (PHCs) in the intervention group and the six remaining serving as controls. Outcomes and adherence to guidelines were measured over the year before the intervention began and for a second 1-year period at the end of the intervention period. Data were collected by chart abstraction. Setting. The study was performed in PHCs in the United Arab Emirates, a newly developed country on the Arabian peninsula. Study participants. Subjects continuously followed in nine PHCs for diabetes care for the period of the study (N = 738) were included in the study. Intervention. Structured diabetes care, including the development of general practice diabetes clinics, a patient education program, a health care professional education program, and improved recording of clinical information, was provided for the 33-month time period. Results. There was a statistically significant improvement in three of the process of care variables (ordering HbA1c, cholesterol, and documenting foot examinations) whereas the four remaining variables did not improve. There was limited impact on outcome variables. Conclusions. The intervention described in this study demonstrated an improvement in some process of care measures suggesting an impact of this type of delivery model in this environment.