Academic journal article Australian Health Review

Review of Patient-Reported Type 2 Diabetes Service Quality

Academic journal article Australian Health Review

Review of Patient-Reported Type 2 Diabetes Service Quality

Article excerpt


A critical review was conducted of the literature from 1960 to June 2005 on service quality in type 2 diabetes. The review demonstrated that improving service quality may improve the outcomes for people with type 2 diabetes. The potential service quality factors from the perspective of people with type 2 diabetes were: timeliness, confidentiality, continuity, dignity, communication, access, education, cost, amenities and autonomy.

Aust Health Rev 2008: 32(1): 23-33

UP TO 7.5% of Australian adults over 25 years old suffer from type 2 diabetes and its related long-term and short-term complications.1 Undiagnosed, untreated or poorly controlled diabetes can lead to serious complications, including renal disease, non-traumatic amputation and blindness among Australians aged under 60 years.2

Early diagnosis and better management of type 2 diabetes can reduce the burden of disease and improve patients' health. Previous studies have shown that improved quality of delivered care in both clinical and non-clinical areas increases quality of life3 and personal satisfaction4 and reduces the disease complications5,6 as well as the overall burden of type 2 diabetes.7

Health systems customers increasingly expect higher quality in their care services aligned with changing trends of diseases, socio-economic issues and advances in medical and health procedures.8 Consequently, patients' needs and expectations should be measured as part of measuring the responsiveness of health care systems.9 Organisational and physical structure and care processes should be designed and built; and delivered care should reflect what patients want from care services.*

Despite the growing consumer-orientated focus in health care, only a small number of studies have focused on this area, and few specifically on type 2 diabetes. This paper aims to review these studies to determine the important service quality factors from the perspective of patients with type 2 diabetes as well as to clarify the relationship of these to other measures of quality and outcomes of care.


MEDLINE and PubMed citations were searched for the period Januaryl960 to June 2005 with keywords: "type 2 diabetes", "qualitative research", "quantitative research", "mixed method research", "quality of care", "service quality", "patients' perspective" and "patient satisfaction". Using this strategy, 23 qualitative and 171 quantitative or mixed method articles from MEDLINE and 6 additional articles from PubMed were found. Titles and abstracts of all articles were reviewed and only 49 papers were found to be related to service quality in type 2 diabetes. In addition, references from the reviewed articles and the latest issues of relevant journals were assessed and 3 additional articles were found (52 in sum).

Selection criteria

All 52 qualitative and quantitative studies that assessed the quality of care and service quality (process quality) for people with type 2 diabetes from any setting and level of health system were reviewed. Five studies in languages other than English, with the exception of the abstract of one article in Spanish, were excluded. The content of the remaining 47 articles was separately reviewed. Of these, 15 studies (32%) from the perspective of doctors (5), nurses (3) and both (7) were excluded to maintain the focus on service quality from the perspective of people with type 2 diabetes. Also excluded were 11 articles (23%) relating to diet, 7 (15%) about foot care and 5 (11%) about ophthalmic care. Finally, applying all inclusion and exclusion criteria (mentioned above), only nine articles (19%) of most relevance to our topic remained (Box 1).


Measurement of service quality in health care

Donabedian, who pioneered the concept of quality improvement in health care and its assessment, introduced three types of measures; "structure", "process" and "outcome", which have been generally accepted and used by others. …

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