Variation in HbA1c prescription for patients with diabetes in French general practice: an observational study prior to the implementation of a P4P programme.
BACKGROUND
Prior to a large diffusion of a pay-for-performance programme (P4P) in primary care in France, it seemed of particular interest to identify, the doctors not performing optimally who could be the main target of this programme. Based on the example of HbA1c prescription for patients with diabetes, this study examined the impact of general practitioner's (GPs) characteristics on the variation of a P4P indicator for diabetes care, i.e. the percentage of patients undergoing three or four HbA1c tests during one year.


METHODS
We used a large database from the national health insurance fund for salaried workers in Brittany to select a cohort of patients with diabetes who had been attended to by their doctors for 1 year. In all, 2545 GPs attending to 41,453 patients with diabetes were included. A two-level hierarchical logistic model was used to analyse the data.


RESULTS
Thirty-six per cent (SD = 22.3) of patients with diabetes underwent three or four HbA1c tests during the year (the target objective was 65% in a patient list). There was a large variability between GPs, even after adjusting for patient characteristics. Doctors who were female, young, working in a group practice, participating in quality-control groups, and who had a lower patient load prescribed the three or four recommended tests more often.


CONCLUSIONS
The results indicate a target group of doctors which require attention. There is still room to improve the quality of care for patients with diabetes in general practice, notably by encouraging doctors to train better and practice in groups.
Département de médecine générale, Faculté de médecine, Université de Rennes, France. nicolaschauvel35@gmail.com
Nicolas
N
Chauvel
Marc
M
Le Vaillant
Nathalie
N
Pelletier-Fleury
D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000188:drug therapy*; D005260:Female; D005602:France; D058006:General Practice / Q000458:organization & administration; D006442:Glycated Hemoglobin / Q000032:analysis*; D006123:Group Practice / Q000458:organization & administration; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007348:Insurance, Health; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010818:Practice Patterns, Physicians' / Q000592:standards / Q000706:statistics & numerical data*; D055656:Prescriptions / Q000706:statistics & numerical data*; D011787:Quality of Health Care; D012052:Reimbursement, Incentive
D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents