Clinical competence and clinical performance in diabetes

Objective. To evaluate at the primary health care level, clinical competence and clinical performance of physicians in the diagnosis and management of diabetes mellitus type II. Material and methods. Physicians in 4 primary medical care units were evaluated using two instruments: a multiple choice questionnaire (true/false/dont know type) with 224 questions about diabetic cases to explore clinical competence, and a second one on management of cases of diabetes to explore the performance in two patients. Both instruments were validated by experts. The instruments were applied simultaneously to 59 physicians in two units and only the competence instrument to another 59 physicians of the other two units. Results. There was a low clinical competence in 57% of the physicians and without differences between the four units. In performance there was a significant differences in favor of the unit with less work load; 56% of the physicians had a very poor performance level. A Spearman correlation competence versus performance was low in both units (0.16 and 0.10). Conclusions. The majority of the physicians had poor or very poor competence and performance and the latter increased under unfavourable working conditions. There was a qualitative difference between our instruments as they were not correlated. It is necessary to improve the working conditions in these units to stimulate their phycisians.