Health care use by diabetic patients in the Netherlands: patterns and predicting factors.
OBJECTIVE
Diabetic patients require care from a variety of health care providers, but little is known about their actual use of health care. Aims of this study were to (1) obtain information on health care use by diabetic patients in the Netherlands, (2) distinguish patterns of health care utilisation among these patients, and (3) develop insight into the factors predicting these patterns.


METHODS
Data on 388 diabetic patients were extracted from a nationally representative database of patients with chronic disease. Data on health care utilisation and background variables were collected in 1998 by means of a survey. Patients' GPs registered information about medical diagnosis, illness duration and co-morbidity. Analysis included descriptive statistics, as well as cluster and logistic analysis.


RESULTS
Diabetic patients use a wide range of services, but large differences exist. Four patterns of health care utilisation could be distinguished: a pattern of low consumption, one of moderate consumption with a central role for internal medicine, one of more extensive diabetes care consumption, and one of high medical and home care consumption. Type 1 diabetes appeared to be an important determinant of the moderate, mainly internal medicine pattern and the more extensive diabetes care pattern. The pattern of high medical and home care was not predicted by diabetes type, but by the presence of co-morbidity and by poor self-rated health.


CONCLUSIONS
Despite the fact that diabetic patients use a wide range of health care services, there seems to be a problem of under utilisation, especially among type 2 diabetic patients.
El Fakiri
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Department of Health Policy and Management, Erasmus Medical Centre, P.O. Box 1738, 3000 DR Rotterdam, Netherlands. elfakiri@bmg.eur.nl
Foets
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Rijken
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D000328:Adult; D000368:Aged; D003922:Diabetes Mellitus, Type 1 / Q000401:mortality* / Q000628:therapy*; D003924:Diabetes Mellitus, Type 2 / Q000401:mortality* / Q000628:therapy*; D005194:Family Practice / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008511:Medicine / Q000706:statistics & numerical data; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D011237:Predictive Value of Tests; D012923:Social Class; D013038:Specialization