Defining quality in type 2 diabetes primary care: A multistakeholder modified Delphi consensus indicator set

Type 2 diabetes mellitus (T2DM) is a growing public‑health challenge in Greece, yet validated tools to assess care quality in primary settings are lacking. We aimed to develop a context‑specific set of consensus‑based quality indicators (QIs) for T2DM in Greek primary care, with an eye toward broader applicability in comparable European and low‑ and middle‑income country (LMIC) systems.

A two-phase study was conducted: (1) a focused bibliographic search (Medline/PubMed and Scopus; January 2019-August 2020) to identify existing T2DM QI sets suitable for primary care; and (2) a three-round modified Delphi survey with 10 stakeholders (general practitioners, diabetologist, dietician, health policy expert, patients) to evaluate indicator importance and feasibility and reach consensus. Candidate indicators were contextually adapted for European relevance prior to Delphi rating.

The bibliographic search identified 16 records; only one study met eligibility criteria and provided 43 candidate QIs. The Delphi process yielded 39 QIs across nine domains: access (2), monitoring (13), health counseling (3), treatment and prevention (2), patient safety (3), records (1), health status (11), patient satisfaction (2), and self-management (2).

We present the first context-adapted, consensus-based T2DM QI set for Greek primary care, covering clinical, organizational, and patient-reported aspects of care. This framework lays the groundwork for wider implementation, electronic health record integration, and international benchmarking.