Abstract
Assessment of diabetes care quality increasingly integrates measurements of patient perceptions. With escalating demand for diabetic services, it is critical to evaluate patients' experiences with patient-centred care and their association with outcome of care indicators. Global satisfaction and experiences with patient-centred care were evaluated in patients with type 2 diabetes. Patients participated in a quality improvement programme set-up as a two-arm clustered randomized trial. The Usual Quality Improvement Programme (UQIP) targeted clinical inertia in primary care physicians. The Advanced Quality Improvement Programme (AQIP) aimed to reduce the rate of clinical inertia and improve the provision of patient-centred care. Objective measures of patient-centred care, including overall satisfaction with care and measures related to health promotion, were associated with mean levels of glycosylated haemoglobin (HbA1c), low-density lipoprotein cholesterol (LDLc) and systolic blood pressure (SBP), measured after 18 months of intervention. The patient response rate was 55.4%. Fifty-nine per cent of patients were very satisfied with quality of care. Overall satisfaction scores and patients' experiences with patient-centred care, did not significantly differ between AQIP and UQIP. The association between overall satisfaction with care and HbA1c levels significantly differed between AQIP and UQIP (P = 0.048). Overall satisfaction with care and LDLc levels did not significantly differ between AQIP and UQIP, or among all patients. The association between overall satisfaction with care and SBP levels, significantly differed between AQIP and UQIP (P = 0.004). Positive experiences with support in the use of oral antidiabetic agents were associated with significantly lower levels of HbA1c in all patients (P = 0.006). Positive experiences with information provision on diabetes mellitus were associated with significantly lower levels of LDLc and SBP (P = 0.036 and 0.010, respectively), as were experiences with information provision on medical treatment (LDLc, P = 0.005; SBP, P = 0.003). In conclusion, results show relatively good performance in both overall satisfaction with quality of care and in all patient-centredness measures examined. Overall satisfaction and measures of patient-centred care are associated with improved outcomes of care, although not consistently.