Effectiveness of pro-active organizational models in primary care for diabetes patients

• Published in: Health policy (Amsterdam) Vol. 123; no. 8; pp. 797 - 802
• Main Authors: Buja, Alessandra, Fusinato, Riccardo, Claus, Mirko, Gini, Rosa, Braga, Mario, Cosentino, Mimma, Boccuzzo, Giovanna, Francesconi, Paolo, Baldo, Vincenzo, Tozzi, Valeria D., Morando, Verdiana, Bellentani, Mariadonata, Damiani, Gianfranco
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01-08-2019; Elsevier Science Ltd
• Subjects: Chronic illnesses; Diabetes; Disease management; Family physicians; Health administration; Health care; Healthcare; Management; Medical treatment; Organizational models; Patients; Performance assessment; Primary care; Primary health care; Quality management; Quality of care; Quasi-experimental methods; Regional variations; Total quality; Healthcare; Diabetes; Disease management; Primary health care; Performance assessment
• ISSN: 0168-8510; 1872-6054
• DOI: 10.1016/j.healthpol.2019.05.014

•Proactive models of primary care resulted in significant better GPs performance scores for diabetes management.•Each region plans and organizes new models of care with different start point performance and different effectiveness.•Further studies, adopting a randomized controlled trial to control for potential selection bias, are warranted.
Demographic changes and chronicity are posing new challenges to health care systems. Our study aimed to examine how effectively the three different types of proactive primary care models adopted by three different regional health care systems in Italy were improving the quality of diabetes management by general practitioners.
A coordinated Italian nationwide project to compare systematically the new proactive organizational models implemented at regional and local level (the MEDINA Project) involved several regions and their local health units (LHUs). A quasi-experimental study was conducted on a large dataset obtained by processing administrative databases. A combined indicator was developed to assess the quality of care delivered by primary care physicians, based on adherence to recommendations concerning patient monitoring and treatment.
The study concerned 602 Italian general practitioners (GPs), 174 of them female, who were caring for a total of 753,366 patients (47,575 of them diabetic). Analyzing a total score, representing global adherence to a quality management of patients with diabetes, confirmed that GPs who had adopted the new model of care for their diabetic patients obtained better results than those who had not, so the new policy was generally effective.
Our study showed that introducing new, proactive primary care models could sustain efforts made around the world to guarantee good-quality chronic disease management in the primary care setting.