[Analysis of the quality of health care for patients with type 2 diabetes enrolled in statutory or private health plans].
OBJECTIVE
Worldwide the quality of care of patients with type 2 diabetes has been investigated only by analysing within cross-sectional studies. But the quality of care in relation to statutory or private health plans in not known. It was the aim of this study to ascertain retrospectively, how in the course of time from first diagnosis the quality of medical care of patients with type 2 diabetes differed depending on the type of health insurance of the individual patient.


METHODS
As part of the ROSSO study (a German retrospective epidemiological cohort study), data on all patients diagnosed with type 2 diabetes between 1.1.1995 and 31.12.1999 had been recorded. They had been collected from 192 randomly selected general practitioner or internal medicine specialist practices.


RESULTS
The data of 3268 patients diagnosed with type 2 diabetes were recorded. The mean observation period was 6.5 years. The mean age of this patients at the time of diagnosis of diabetes was 62.4 +/- 9.6 years, 49 % being male. The portion of patients visiting their chosen practice at least 3 - 4 times in a given year was about 70 - 80 %. Documentation of HbA (1c) or blood pressure as requested in the guideline was presented in 20 - 50 % of patient files with no differences between enrolled in a statutory or private health plans. Even when cholesterol or blood pressure levels were greatly elevated 20 - 50 % of patients had been prescribed no adequate drug treatment. Only 20 % of the patients had been described platelet aggregation inhibitors during the first years after myocardial infarction or stroke.


CONCLUSIONS
The quality of care in general practitioner of specialist internal medicine practices failed to meet the guidelines for patients with type 2 diabetes. There were no differences that depended on whether the patients had been enrolled in a statutory or private health plan.
Westdeutsches Diabetes- und Gesundheitszentrum, Sana Kliniken Düsseldorf GmbH. s.martin@sana-duesseldorf.de
S
S
Martin
L
L
Heinemann
V
V
Lodwig
B
B
Schneider
H
H
Kolb
D001795:Blood Pressure Determination; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000628:therapy*; D005194:Family Practice / Q000592:standards; D005260:Female; D005858:Germany; D006442:Glycated Hemoglobin / Q000032:analysis; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D006937:Hypercholesterolemia / Q000188:drug therapy; D006973:Hypertension / Q000188:drug therapy; D007348:Insurance, Health / Q000145:classification* / Q000592:standards; D007388:Internal Medicine / Q000592:standards; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000188:drug therapy; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D017064:Process Assessment, Health Care; D011787:Quality of Health Care; D012189:Retrospective Studies; D020521:Stroke / Q000188:drug therapy
D002784:Cholesterol; D006442:Glycated Hemoglobin; D010975:Platelet Aggregation Inhibitors
Analyse der Versorgungsqualität bei Typ-2-Diabetes bei gesetzlich und privat versicherten Patienten.