Non-communicable diseases are the main cause of disability and premature death of the population. Diabetes is one of the most common non-infectious diseases. In various countries of the world, the number of patients with diabetes is 4-7% of the total population. Today, there are 371 million patients in the world, and by 2025, 552 million patients with diabetes are expected, which creates the prerequisites for considering diabetes as a global pandemic. The most common form of diabetes is type 2, which accounts for 90-95% of all cases in the world.
According to the updated recommendations of the American Diabetes Association 2021, to optimize the management of patients with diabetes, new approaches, methods and technologies of dynamic monitoring and treatment are needed, which will improve medical care and strengthen the health of the population, by implementing behavioral mechanisms to actively involve patients in continuous control/ self-monitoring of glycemic status. The development of digital technologies and tools in health care contributes to the improvement of the quality of medical care, in particular at the level of primary care. However, effective information technologies that are patient-oriented and based on the principles of healthy behavioral theory remain insufficiently studied and not implemented at the national level.
The aim of the dissertation was to substantiate the optimization of the quality management system of medical care for patients with type 2 diabetes at the level of the primary health care unit using an automated information and communication system for remote monitoring. The following methods were used to analyze and substantiate the research results: systematic approach, bibliosemantic, comparative and statistical analysis, logical generalization, sociological, descriptive modeling, design of information-analytical schemes, organizational experiment.
During the implementation of the dissertation research, a trend of increasing the prevalence of diabetes among the adult population of the Sumy region during the studied period from 3,404.5 cases per 100,000 population in 2017 to 4,182.9 cases per 100,000 population in 2020, i.e. by 23 %. Incidence in 2020 is 335.2 cases per 100,000 population, and in 2017 - 305.5 cases per 100,000 population (a 9.8% increase).
It was established that all respondents were informed about the influence of modified risk factors on the development of complications of diabetes, but they are not followed. Every second person has an individual glucometer, but 47.9% of people monitor their blood sugar levels only once a month or less. Only 40.6% of people were tested for HbA1c level once a year, 28.1% of people did not have data on HbA1c testing for the studied period.
The information and communication system "Remote medical service in the quality management system of medical care at the primary level" was developed and implemented to improve self-control by patients with type 2 diabetes for their own health, as well as to encourage regular compliance with the doctor's recommendations.
The effectiveness of the implementation of the information and communication system was proven by the positive impact on quality indicators: the share of patients who regularly monitor their blood pressure increased by 32.3%, and their glycemic level increased by 35.4%. The share of patients who were tested for HbA1c level once every 3 months increased by 33.4% and 35.4% more people were tested once every 5-6 months. The share of people with a target blood pressure level (≥140/90 mmHg) increased by 25.0%, and the share of people with a satisfactory level of diabetes compensation (fasting blood glucose within 4.4) increased by 29.1% -6.7 mmol/l), the share of people with a target level of HbA1c (<7%) increased by 19.8%, and with a level of HbA1c >7% - <8% increased by 26% of people. Therefore, the level of self-monitoring of glycemic status among the studied group of patients increased.
Patients became more motivated to self-monitor HbA1c and during the period of introduction of ICS, they were examined once or twice: 42.7% of people were examined once every 3 months (33.4% increase in the indicator), and 57.3% of people were examined once every 5-6 months (35.4% growth rate). 12.5% more respondents began to regularly take medications prescribed by the doctor, 28.1% more respondents began to adhere to the diet and nutrition regime, which indicates the positive impact of the implementation on their motivation to follow the recommendations of the attending physician.
