Quality of care and outcomes in type 2 diabetic patients a comparison between general practice and diabetes clinics

The role of general practice and diabetes clinics in the management of diabetes is still a matter of debate. Methodological flaws in previous studies may have led to inaccurate conclusions when comparing the care provided in these different settings. We compared the care provided to type 2 diabetic...

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Published in:	Diabetes care Vol. 27; no. 2; pp. 398 - 406
Main Authors:	DE BERARDIS, Giorgia, PELLEGRINI, Fabio, VALENTINI, Miriam, NICOLUCCI, Antonio, FRANCIOSI, Monica, BELFIGLIO, Maurizio, DI NARDO, Barbara, GREENFIELD, Sheldon, KAPLAN, Sherrie H, ROSSI, Marie C. E, SACCO, Michele, TOGNONI, Gianni
Format:	Journal Article
Language:	English
Published:	Alexandria, VA American Diabetes Association 01-02-2004
Subjects:	Aged Ambulatory Care Facilities - standards Biological and medical sciences Comparative analysis Diabetes Diabetes Mellitus, Type 2 - blood Diabetes Mellitus, Type 2 - physiopathology Diabetes Mellitus, Type 2 - therapy Diabetes. Impaired glucose tolerance Endocrine pancreas. Apud cells (diseases) Endocrinopathies Etiopathogenesis. Screening. Investigations. Target tissue resistance Family Practice - standards Female Humans Italy Male Management Medical sciences Middle Aged Patient outcomes Physicians Practice Quality Assurance, Health Care Surveys and Questionnaires Treatment Outcome Type 2 diabetes Italy United States Endocrinopathy Type 2 diabetes Human Prognosis Quality Comparative study Care
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Summary:	The role of general practice and diabetes clinics in the management of diabetes is still a matter of debate. Methodological flaws in previous studies may have led to inaccurate conclusions when comparing the care provided in these different settings. We compared the care provided to type 2 diabetic patients attending diabetes outpatient clinics (DOCs) or being treated by a general practitioner (GP) using appropriate statistical methods to adjust for patient case mix and physician-level clustering. We prospectively evaluated the process and intermediate outcome measures over 2 years in a sample of 3,437 patients recruited by 212 physicians with different specialties practicing in 125 DOCs and 103 general practice offices. Process measures included frequency of HbA(1c), lipids, microalbuminuria, and serum creatinine measurements and frequency of foot and eye examinations. Outcome measures included HbA(1c), blood pressure, and total and LDL cholesterol levels. Differences for most process measures were statistically significantly in favor of DOCs. The differences were more marked for patients who were always treated by the same physician within a DOC and if that physician had a specialty in diabetology. Less consistent differences in process measures were detected when patients followed by GPs were compared with those followed by physicians with a specialty other than diabetology. As for the outcomes considered, patients attending DOCs attained better total cholesterol levels, whereas no major differences emerged in terms of metabolic control and blood pressure levels between DOCs and GPs. Physicians' specialties were not independently related to patient outcomes. Being followed always by the same physician in a DOC, particularly if the physician had a specialty in diabetes, ensured better quality of care in terms of process measures. In the short term, care provided by DOCs was also associated with better intermediate outcome measures, such as total cholesterol levels.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0149-5992 1935-5548
DOI:	10.2337/diacare.27.2.398