Quality of Care and Outcomes in Type 2 Diabetic Patients

A comparison between general practice and diabetes clinics

  1. Giorgia De Berardis, MSC (PHARM CHEM)1,
  2. Fabio Pellegrini, MS1,
  3. Monica Franciosi, MSC (BIOL)1,
  4. Maurizio Belfiglio, MD1,
  5. Barbara Di Nardo, HSDIP1,
  6. Sheldon Greenfield, MD2,
  7. Sherrie H. Kaplan, PHD MPH2,
  8. Marie C.E. Rossi, MSC (PHARM CHEM)1,
  9. Michele Sacco, MD1,
  10. Gianni Tognoni, MD1,
  11. Miriam Valentini, MD1,
  12. Antonio Nicolucci, MD1 and
  13. on behalf of the QuED Study Group*
  1. 1Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy
  2. 2Center for Health Policy Research, University of California, Irvine, Irvine, California
  1. Address correspondence and reprint requests to Antonio Nicolucci, MD, Department of Clinical Pharmacology and Epidemiology, Consorzio Mario Negri Sud, Via Nazionale, 66030 S. Maria Imbaro, Chieti, Italy. E-mail: nicolucci{at}negrisud.it

Abstract

OBJECTIVE—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.

RESEARCH DESIGN AND METHODS—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 HbA1c, lipids, microalbuminuria, and serum creatinine measurements and frequency of foot and eye examinations. Outcome measures included HbA1c, blood pressure, and total and LDL cholesterol levels.

RESULTS—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.

CONCLUSIONS—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.

Footnotes

  • A table elsewhere in this issue shows conventional and Système International (SI) units and conversion factors for many substances.

  • *

    * A complete list of the QuED Study Group can be found in the appendix.

    • Accepted October 23, 2003.
    • Received June 4, 2003.
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