Medical Audit of Diabetes Mellitus in Primary Care Setting in Bosnia and Herzegovina

Aim To assess the quality of diabetes care provided by family medicine teams in primary health centers in Bosnia and Herzegovina (BH) through a medical audit, addressing the extent to which clinical practice complied with pre-determined explicit criteria of long-term management. Method Retrospective analysis included randomly selected medical records of patients with type 1 or 2 diabetes mellitus treated by 18 family medicine teams at 5 locations in BH, included in the Canadian International Development Agency/World Health Organization project "Strengthening health care system in BH with focus on primary health care/family medicine model." Audit record form contained 24 questions on sex, age, diabetes type, body mass index (BMI), hypertension, family anamnesis, annual examinations (HbA(1)C, BMI, lipid profile or total cholesterol, blood creatinin, neurological examination, urinanalysis for albuminuria, foot care, and examination of ocular fundus), smoking habits, alcohol consumption, patient education, prescribed insulin and other drugs, and patient's health care-seeking behavior. Standardized and record forms were returned anonymously with 99.3% response rate. Results Records of 536 patients with diabetes were analyzed (64% women and 87% patients with diabetes mellitus type 2). Family medicine teams showed poor compliance with established criteria for diabetes control. Metabolic control (69.5%) was acceptable, but the level of monitoring complications of diabetes (foot and ocular fundus examined in 53.4% and 53% of patients, respectively) was low. There were also considerable variations in diabetes management between different centers as well as between the teams in the same center. Conclusion The audit revealed deficiencies in the quality of diabetes care and variations in care provision between primary care teams. Clinical guidelines and continuing education about acceptable diabetes care should be developed and implemented in BH.