Tkachenko V. Scientific substantiation and ways to optimize the management of patients with type 2 diabetes in primary care.

The object of study: health care system for adult patients with type 2 diabetes mellitus (DM). Objective: to substantiate scientifically and to optimize the system of management of patients with type 2 diabetes in primary health care (PHC) in Ukraine on the basis of retrospective analysis of medical care state on the example of Kyiv region, the study of modern trends and the quality (effectiveness) providing diabetes care in the world and evaluation of the implementation of new medical and technological documents. Methods: retrospective analysis of medical data of type 2 diabetes patients, analysis of the results of statistical reports of health care establishments, general clinical, laboratory (blood and urine tests, blood glucose and glycated hemoglobin, lipidogram, blood chemistry, urine albumin / creatinine ratio, microalbuminuria, proteinuria, glomerular filtration rate), instrumental (blood pressure measurement, carbon monoxide in exhaled air, the study of the fundus, echocardiography, Doppler) examination and survey of patients with type 2 diabetes, survey of doctors, statistical methods. Scientific novelty: for the first time for Ukraine the necessity of PC doctors involvement was grounded due to increasing prevalence and incidence of diabetes, constant staffing endocrinologists and increasing staffing and resources of PC, positive experience in overseas countries. New national clinical protocol for diabetes management in PC and methodology for assessing its implementation were developed. A comprehensive assessment of diabetes care quality for 2 years of new clinical protocol implementation has shown its improvement in 2.05 times, but its level was low (37 %). The significant differences between quality indicators and results of diabetes care in patients of PC doctors and endocrinologists was not found, that confirms the positive effect of involvement of PC doctors in diabetes management (integral efficiency ratio KiPC = 0.173, Kiendocrinologist = 0.165). Optimization of diabetes primary care was carried out by the development of local protocols, improvement the knowledge of doctors, nurses and patients, the accounting system of assessment and monitoring of quality of care, its indicators.