Determinants of ambulatory care in a defined adult Swedish diabetic population.
OBJECTIVE
To investigate factors associated with health care utilisation in ambulatory diabetes care in relation to complications attributable to diabetes mellitus in an adult diabetic population.


METHODS
A cross-sectional study; standardised interview, physical examination, and an evaluation of medical records, comprising all known diabetic subjects living in six primary health care districts in southern Sweden (N = 1861, aged > 25 years; 90.1% participation).


RESULTS
People managed by specialists (17.2%) had more complications related to diabetes and were more often treated with insulin. Persons managed in health care centres with a diabetes nurse specialist used insulin more often, used self-monitoring of blood glucose (SMBG) more regularly, lived on their own, and used meals on wheels and Community Care Alarm Service more frequently than those managed in other health centres. Multiple logistic regression analysis showed high utilisation of office visits to physicians ( > 5 visits) to be mainly associated with the presence of a foot ulcer (OR (95% CI) 2.1 (1.4-3.3)), congestive heart failure (1.6 (1.1-2.3)), and cardio-cerebrovascular disease (1.4 (1.1-1.9)). High utilisation of visits to other care-givers ( > 4 visits) was related to current or previous foot ulcers (2.4 (1.5-3.7) and 2.1 (1.2-3.5)), meals on wheels (1.9 (1.2-3.0)), and treatment with insulin (1.6 (1.2-2.1)).


CONCLUSIONS
High utilisation of ambulatory diabetes care was mainly associated with health status and complications related to diabetes, particularly diabetic foot ulcers. Organisational factors such as managed care with access to a diabetes nurse specialist in a health care centre was related to increased use of self-monitoring of blood glucose and insulin treatment. Visits to other care-givers were associated with access to social welfare. In diabetes care, activities to promote health and prevent complications need to be stressed.
Hjelm
Katarina
K
Department of Community Health Sciences Malmö, University of Lund, Sweden. katarina.hjelm@ivosa.vxu.se
Nyberg
Per
P
Apelqvist
Jan
J
D000284:Administration, Oral; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000554:Ambulatory Care Facilities / Q000706:statistics & numerical data*; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000628:therapy*; D016523:Foot Ulcer / Q000453:epidemiology; D005843:Geography; D006801:Humans; D007004:Hypoglycemic Agents / Q000008:administration & dosage / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data; D012044:Regression Analysis; D012648:Self Care; D013038:Specialization; D013548:Sweden
D007004:Hypoglycemic Agents; D007328:Insulin