Q Manage Health Care Vol. 15, No. 1, pp. 58–65 c  2006 Lippincott Williams & Wilkins, Inc. The Need for Quality Management in Primary Health Care in Cyprus: Results From a Medical Audit for Patients With Type 2 Diabetes Mellitus Theodora Zachariadou, MD; Loukia Makri, MSc; Henri E. J. H. Stoffers, MD, PhD; Anastasios Philalithis, PhD, AKC, MBBS, MRCP, MSc; Christos Lionis, MD, PhD Objectives: To assess the quality of clinical management regarding metabolic and blood pressure control in a cohort of patients with type 2 diabetes in the primary health care setting of Cyprus. Subjects and Methods: Medical care, received by 296 patients with type 2 diabetes from 4 primary care health centers in Cyprus, was assessed for 1 year. Data were collected retrospectively using chart review and a telephone survey. Most recent values of HbA 1c , fasting blood glucose, blood pressure, and lipid values were used to assess attainment to internationally accepted treatment targets. Results: Mean age was 70 years, 75% of patients being older than 65. Average diabetes duration was 13 years. Almost 90% of patients had visited a general practitioner during 1 year, on average 8.3 times. Hypertension and hyperlipidemia were present in 67% and 32% of patients, respectively. Overall, diabetes care provided by the 4 primary care health centers appeared to be suboptimal with regard to frequency of metabolic and blood pressure measurements as well as targets reached. Only 10.5% of all patients had at least 1 HbA 1c value recorded, and 77.4% of them had HbA 1c levels of 8% or more. Of the patients who had a low-density lipoprotein cholesterol measurement during the examined year (29.4%), only 20.7% had a value less than 100 mg/dL. Only 34.5% of patients used lipid-lowering agents, and only 15.9% were receiving aspirin. Conclusion: Our findings suggest that the management of type 2 diabetes is suboptimal in the primary health care setting of Cyprus. A multifaceted intervention, already in progress in 2 health centers, is expected to improve the quality of diabetes care. Key words: primary health care, quality management, type 2 diabetes T ype 2 diabetes is one of the most common chronic diseases, with increasing preva- lence over the last 30 years. It has been es- timated that between the years 1995 and 2025 the prevalence of diabetes in adults will in- crease by 35% for the whole world. 1 Furthermore, type 2 diabetes is a major contributor to the development of cardiovascular disease, leading to increased mortality, 2 particularly, among patients with concomitant hypertension or hyperlipidemia. 3 In Cyprus, a new national health plan has recently been approved by law, introducing the “gatekeeper role” for general practitioners in the primary health care services. Taking this reform into consideration, a collaborative agreement between the Ministry of Health and the School of Medicine of the Univer- sity of Crete was signed. The objective of this project is to improve quality management in the primary From the Nicosia General Hospital (Dr Zachariadou) and the Statistical Service of Cyprus (Ms Makri), Nicosia, Cyprus; the Department of General Practice, Maastricht University, Maastricht, the Netherlands (Dr Stoffers); and the Department of Social and Family Medicine, School of Medicine, University of Crete, Heraklion, Greece (Drs Philalithis and Lionis). Dr Zachariadou is a PhD stu- dent at the University of Crete, Heraklion, Greece. Corresponding author: Theodora Zachariadou, MD, 1, Spy- rou Lambrou, 1082, Nicosia, Cyprus (e-mail: andthe@ cytanet.com.cy). 58