A comparative study of two various models of organising diabetes follow-up in public primary health care - the model influences the use of services, their quality and costs.
BACKGROUND
In Finland diabetologists have long been concerned about the level of diabetes care as the incidence of type 1 diabetes and complicated type 2 diabetes is exceeding the capacity of specialist clinics. We compared the outcome of diabetes care in two middle-sized Finnish municipalities with different models of diabetes care organisation in public primary health care. In Kouvola the primary health care of all diabetic patients is based on general practitioners, whereas in Nurmijärvi the follow-up of type 1 and most complicated type 2 diabetic patients is assigned to a general practitioner specialised in diabetes care.


METHODS
Our study population consisted of all adult diabetic patients living in the municipalities under review.We compared the use and costs of public diabetes care, glycemic control, blood pressure, LDL-cholesterol level, the application of the national guidelines and patient satisfaction. The main outcome measures were the costs and use of health care services due to diabetes and its complications.


RESULTS
In Nurmijärvi, where diabetes care was centralised, more type 1 diabetic patients were followed up in primary health care than in Kouvola, where general practitioners need more specialist consultations. The centralisation resulted in cost savings in the diabetes care of type 1 diabetic patients. Although the quality of care was similar, type 1 diabetic patients were more satisfied with their follow-up in the centralised system. In the care of type 2 diabetic patients the centralised system required fewer specialist consultations, but the quality and costs were similar in both models.


CONCLUSIONS
The follow-up of most diabetic patients - including type 1 diabetes - can be organised in primary health care with the same quality as in secondary care units. The centralised primary care of type 1 diabetes is less costly and requires fewer specialist consultations.
Nurmijärvi Health Centre, Network of Academic Health Centres, University of Helsinki, University Central Hospital of Helsinki, Unit of General Practice, Helsinki, Finland. mikko.honkasalo@nurmijarvi.fi.
Mikko T
MT
Honkasalo
Miika
M
Linna
Timo
T
Sane
Atte
A
Honkasalo
Outi
O
Elonheimo
D000293:Adolescent; D000328:Adult; D000368:Aged; D003695:Delivery of Health Care / Q000191:economics / Q000706:statistics & numerical data; D048909:Diabetes Complications / Q000453:epidemiology / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000191:economics / Q000628:therapy*; D003922:Diabetes Mellitus, Type 1 / Q000191:economics / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000191:economics / Q000628:therapy; D005387:Finland / Q000453:epidemiology; D017048:Health Care Costs / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008875:Middle Aged; D017146:Models, Organizational; D011320:Primary Health Care / Q000191:economics / Q000458:organization & administration* / Q000592:standards / Q000706:statistics & numerical data; D011787:Quality of Health Care; D055815:Young Adult