Quality of diabetes care in family medicine practices in eastern Bosnia and Herzegovina

• The frequency of the use of screening tests for chronic diabetes complications was found to be low.
• Specialists in family medicine provided a higher number of screening tests compared to other physicians.
• Larger number of diabetics per practice was associated with smaller number of tests.
• Screening awareness among primary care providers should be improved.
• Availability of the tests has a great influence on their use.

ObjectivesIn the present study, the audit of medical files of patients with diabetes, followed in family medicine practices in the eastern region of Bosnia and Herzegovina (BiH), was carried out in order to investigate the frequency of the use of screening tests for early diagnosis of diabetes complications.MethodsThe audit was conducted in 32 family medicine practices from 12 primary health care centers in the eastern part of BiH over one-year period (March 2010 to March 2011). A specially established audit team randomly selected medical files of 20 patients with diabetes from the Diabetes Registry administered by each family medicine team database. Screening tests assessed are selected according to the ADA guidelines.ResultsFrequency of the individual screening test varied between 99%, found for at least one blood pressure measurement, and 3.8% for ABI measurement. When the frequency of optimal use of screening was analyzed, only 1% of patients received all recommended screening tests.ConclusionThe frequency of the use of screening tests for chronic diabetes complications was found to be low in the eastern part of Bosnia and Herzegovina. Multivariate linear regression analysis showed that longer duration of diabetes and a larger number of diabetics per practice were associated with a smaller number of screening tests, but specialists in family medicine provided a higher number of screening tests compared to other physicians.