Patterns of care as a risk factor for the development of vision-threatening diabetic retinopathy: a population-based matched case-control study using insurance claims (Medicare) data.
OBJECTIVE
To evaluate systematically the effectiveness of the primary healthcare system in Australia in preventing the development of advanced diabetes complications.


METHODS
Diabetes patients (n = 4632) who had received their first laser photocoagulation treatment in 2000 were compared with a random sample of diabetes patients who had never received this treatment (n = 4632). Patterns of health care utilization were compared over a 7-year period (1993-1999) using the Australian Medicare database.


RESULTS
There were significant differences in levels of healthcare utilization: cases were less likely to attend a general practitioner, from odds ratio (OR) = 0.21 (P < 0.0001) in 1993 to 0.53 (P < 0.0001) in 1999; less likely to be tested for HbA(1c), from OR = 0.24 in 1997 (P < 0.0001) to 0.38 in 1999 (P < 0.0001); for HDL-cholesterol, from OR = 0.017 (P < 0.0001) in 1999 to 0.04 (P < 0.0001) in 1993; and to attend specialists and consultant physicians, from OR = 0.25 (P < 0.0001) in 1994 to 0.44 (P < 0.0001) in 1999. The multivariate analysis emphasized the importance of timely diagnosis, HDL-cholesterol testing and optometry attendances in the prevention of advanced diabetes complications.


CONCLUSIONS
The study supports the contention that healthcare utilization may be as important a determinant of health outcomes as clinical risk factors such as blood glucose control. This highlights the importance of early diagnosis and the need to address systemic barriers so as to increase primary care utilization for people at risk of advanced diabetes complications.
Orr
N J
NJ
Department of Diabetes and Endocrinology, The University of Sydney at Westmead Hospital, Sydney, Australia. norr5173@yahoo.com.au
Boyages
S C
SC
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D016022:Case-Control Studies; D002648:Child; D003920:Diabetes Mellitus / Q000517:prevention & control*; D003930:Diabetic Retinopathy / Q000453:epidemiology* / Q000517:prevention & control; D005260:Female; D006801:Humans; D007344:Insurance Claim Reporting; D008028:Light Coagulation; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D012307:Risk Factors