Quality of care and outcomes in type 2 diabetic patients: a comparison between general practice and diabetes clinics.
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.


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 HbA(1c), lipids, microalbuminuria, and serum creatinine measurements and frequency of foot and eye examinations. Outcome measures included HbA(1c), 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.
De Berardis
Giorgia
G
Department of Clinical Pharmacology and Epidemiology, Istituto di Ricerche Farmacologiche Mario Negri, Consorzio Mario Negri Sud, S. Maria Imbaro, Chieti, Italy.
Pellegrini
Fabio
F
Franciosi
Monica
M
Belfiglio
Maurizio
M
Di Nardo
Barbara
B
Greenfield
Sheldon
S
Kaplan
Sherrie H
SH
Rossi
Marie C E
MC
Sacco
Michele
M
Tognoni
Gianni
G
Valentini
Miriam
M
Nicolucci
Antonio
A
D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology / Q000628:therapy*; D005194:Family Practice / Q000592:standards*; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D011785:Quality Assurance, Health Care; D011795:Surveys and Questionnaires; D016896:Treatment Outcome