Background
Methods
Study design
Healthcare utilisation in primary care
Patient and disease characteristics
Statistical analyses
Results
Diabetes-related primary healthcare | Total primary healthcare | |||||
---|---|---|---|---|---|---|
Profile 1
|
Profile 2
|
Profile 3
|
Profile 1
|
Profile 2
|
Profile 3
| |
‘high utilisation and frequent home visits’(n=393)
| ‘low utilisation, GP only’(n=3231)
| ‘high utilisation, GP and nurse’ (n=3097)
| ‘low utilisation, GP only’(n =2669)
| ‘medium-high utilisation, GP and nurse”(n=2929)
| ‘high utilisation’ (n=1123)
| |
mean (95% CI)
|
mean (95% CI)
|
mean (95% CI)
|
mean (95% CI)
|
mean (95% CI)
|
mean (95% CI)
| |
Number per year
| ||||||
GP contacts | 0.45 (0.34-0.59) | 1.65 (1.30-2.10) | 1.59 (1.27-1.98) | 4.38 (3.84-4.99) | 4.34 (3.65-5.17) | 5.67 (4.37-7.36) |
GP home visits | 1.08 (0.88-1.32) | 0.19 (0.14-0.27) | 0.05 (0.02-0.10) | 0.15 (0.09-0.26) | 0.09 (0.06-0.14) | 3.95 (3.07-5.07) |
GP telephone consultation | 0.95 (0.70-1.30) | 0.28 (0.21-0.38) | 0.30 (0.24-0.39) | 0.81 (0.58-1.11) | 0.86 (0.69-1.08) | 4.15 (3.55-4.85) |
Primary care nurse contacts | 0.41 (0.27-0.63) | 0.09 (0.04-0.21) | 3.48 (3.01-4.03) | 0.08 (0.04-0.20) | 3.75 (3.33-4.23) | 1.15 (0.58-2.31) |
Primary care nurse home visits | 2.71 (2.23-3.29) | 0.00 (0.00-0.01) | 0.69 (0.50-0.94) | 0.00 (0.00-0.01) | 0.02 (0.01-0.04) | 1.27 (0.83-1.94) |
Primary care nurse telephone consultation | 1.99 (1.13-3.50) | 0.01 (0.00-0.03) | 0.68 (0.47-0.98) | 0.01 (0.00-0.03) | 0.60 (0.40-0.91) | 1.26 (0.72-2.23) |
Number of different prescription (ATC4-level) | 4.42 (4.14-4.69) | 3.28 (3.13-3.43) | 3.68 (3.52-3.84) | 6.70 (6.12-7.28) | 7.23 (6.62-7.84) | 13.28 (12.65-13.91) |
Referral to (%)
| ||||||
Dietician | 1.6% | 1.0% | 1.3% | 1.6% | 2.8% | 2.5% |
Physiotherapist | 4.3% | 3.3% | 4.9% | 5.7% | 8.6% | 13.7% |
Podiatrist | 1.5% | 0.3% | 1.4% | 4.2% | 2.9% | 2.6% |
Diabetes-related primary healthcare | |||
---|---|---|---|
Profile 1
|
Profile 2
|
Profile 3
| |
‘high utilisation and | ‘low utilisation, GP only’ | ‘high utilisation, | |
frequent home |
(n=3231)
| GP and nurse’ | |
visits’ |
(n=3097)
| ||
(n=393)
| |||
Gender (% female) | 73.5 | 50.8 | 48.0 |
Age
| |||
18-34 | 0.3 | 1.7 | 0.5 |
35-44 | 0.8 | 5.9 | 3.7 |
45-54 | 1.0 | 14.3 | 13.2 |
55-64 | 3.3 | 26.3 | 29.4 |
65-74 | 16.8 | 26.1 | 30.6 |
75 and older | 77.9 | 25.7 | 22.5 |
Urbanisation | |||
2500 or more addresses per square km | 27.0 | 26.5 | 13.2 |
1500-2499 addresses per square km | 20.9 | 27.3 | 31.8 |
1000-1499 addresses per square km | 20.9 | 21.8 | 13.3 |
500-999 addresses per square km | 14.5 | 11.3 | 15.7 |
<500 addresses per square km | 16.8 | 13.1 | 26.0 |
Main medication
| |||
No medication | 16.0 | 32.3 | 25.1 |
Oral medication only | 61.3 | 54.6 | 61.6 |
Oral medication and insulin | 22.7 | 13.1 | 13.3 |
Related comorbidity
| |||
Heart diseases | 21.4 | 10.5 | 15.2 |
Stroke | 10.7 | 3.3 | 3.2 |
Retinopathy | 1.0 | 0.5 | 0.6 |
Nephropathy | 6.6 | 1.9 | 2.6 |
Diabetic foot | 2.8 | 2.1 | 1.8 |
Non-related comorbidity
| |||
Depression | 8.7 | 3.9 | 4.3 |
Lung diseases | 18.1 | 9.0 | 12.0 |
Musculoskeletal diseases | 36.4 | 27.0 | 28.0 |
Neurological diseases | 2.0 | 1.2 | 1.1 |
Cancer | 8.1 | 3.7 | 3.4 |
Profiles of diabetes-related primary healthcare utilisation
Diabetes-related healthcare | |||
---|---|---|---|
Profile 1 ‘high utilisation and frequent home visits’ |
Profile 3 ‘high utilisation, GP and nurse’ |
Profile 1 ‘high utilisation and frequent home visits’ | |
(Profile 2 ‘low utilisation, GP only’= reference group)
|
(Profile 2 ‘low utilisation, GP only’= reference group)
|
(Profile 3 ‘high utilisation, GP and nurse’= reference group)
| |
Patient and disease characteristics
|
Odds ratio (95% CI)
|
Odds ratio (95% CI)
|
Odds ratio (95% CI)
|
Gender (reference male) |
1.80 (1.38-2.34)
| 0.92 (0.83-1.02) |
2.27 (1.76-2.93)
|
Age (reference 18–44)
| |||
45-54 | 0.43 (0.09-1.92) |
1.46 (1.12-1.90)
| 0.35 (0.07-1.72) |
55-64 | 0.71 (0.21-2.41) |
1.64 (1.29-2.10)
| 0.48 (0.13-1.82) |
65-74 |
3.24 (1.08-9.69)
|
1.74 (1.36-2.22)
| 2.22 (0.67-7.39) |
75 and older |
16.20 (5.55-47.27)
| 1.26 (0.98-1.62) |
15.47 (4.76-50.27)
|
Urbanisation (reference: 2500 or more addresses per square km) | |||
1500-2499 addresses per square km |
0.61 (0.38-0.99)
| 1.19 (0.94-1.52) |
0.57 (0.36-0.90)
|
1000-1499 addresses per square km | 0.69 (0.40-1.21) | 1.11 (0.83-1.48) | 0.65 (0.38-1.10) |
500-999 addresses per square km | 0.58 (0.30-1.12) | 1.14 (0.82-1.60) |
0.53 (0.28-1.00)
|
<500 addresses per square km | 0.66 (0.34-1.29) | 1.17 (0.80-1.72) | 0.60 (0.32-1.15) |
Main medication form (reference: no medication)
| |||
Oral medication only |
2.16 (1.58-2.96)
|
1.61 (1.43-1.82)
|
1.53 (1.13-2.06)
|
Oral medication and insulin |
3.46 (2.35-5.10)
| 1.15 (0.96-1.37) |
3.24 (2.25-4.67)
|
Related comorbidity
| |||
Heart diseases | 1.04 (0.76-1.44) | 0.99 (0.85-1.15) | 1.14 (0.85-1.53) |
Stroke |
1.90 (1.25-2.89)
| 0.76 (0.57-1.01) |
2.92 (2.00-4.27)
|
Retinopathy | 1.28 (0.37-4.50) | 1.43 (0.73-2.82) | 0.55 (0.14-2.18) |
Nephropathy | 1.34 (0.78-2.28) | 0.88 (0.62-1.24) |
1.65 (1.00-2.70)
|
Diabetic foot | 1.01 (0.48-2.11) | 0.88 (0.61-1.27) | 1.21 (0.62-2.36) |
Non-related comorbidity
| |||
Depression | 1.50 (0.96-2.35) | 1.03 (0.80-1.32) |
1.72 (1.15-2.56)
|
Lung diseases |
1.44 (1.04-1.98)
| 1.00 (0.85-1.18) |
1.40 (1.03-1.89)
|
Musculoskeletal diseases | 1.20 (0.94-1.55) | 1.05 (0.94-1.17) | 1.20 (0.95-1.51) |
Neurological diseases | 1.06 (0.45-2.49) | 0.75 (0.46-1.22) | 1.89 (0.91-3.91) |
Cancer | 1.34 (0.84-2.14) | 0.80 (0.61-1.06) |
1.84 (1.20-2.82)
|
Profiles of total primary healthcare utilisation
Comparing membership of profiles of diabetes-related primary care with membership of profiles of total primary healthcare utilisation
Diabetes-related primary healthcare | |||
---|---|---|---|
Total primary healthcare
|
Profile 1 ‘high utilisation and frequent home visits’ (n=393) |
Profile 2 ‘low utilisation, GP only’ (n=3231) |
Profile 3 ‘high utilisation, GP and nurse’ (n=3097) |
Profile 1
| 4 | 2661 | 4 |
‘low utilisation, GP only’ (n=2669) | |||
Profile 2
| 3 | 130 | 2796 |
‘ medium-high utilisation, GP and nurse” (n=2929) | |||
Profile 3
| 386 | 440 | 297 |
‘high utilisation’ (n= 1123) |