The effect of continuous monitoring of hypertension and type 2 diabetes mellitus on the number of visits to medical specialists and hospitalization: a retrospective study.
OBJECTIVE
The aim of the study was to determine whether the implementation of the quality system (QS) in primary healthcare made the care of chronically ill patients in family practice more consistent and reduced the load in specialized medical care.


METHODS
A quantitative retrospective cohort study using the database of the Estonian Health Insurance Fund was provided. Patients with diagnosed essential hypertension (HYP) and/or type 2 diabetes mellitus (DM2) formed the study group. If the family physician met the criteria for the monitoring of patients with DM2 and HYP set in the QS, the result was defined as positive. The number of disease-specific hospitalizations, the length of hospital stay, and the number of visits to family physicians and medical specialists due to HYP or DM2 in 2005-2008 were evaluated.


RESULTS
Chronically ill patients (DM2 and HYP) in the lists of family physicians with a positive QS result were 1.26 times more likely (95% CI, 1.25-1.28) to be continuously monitored than those in the lists of family physicians with a negative QS result. The 2 coexisting chronic diseases (DM2 and HYP) increased the chance of being continuously monitored and increased the number of visits. The chance of being monitored by a medical specialist alone was reduced if the family physician participated in the QS (OR, 0.66; 95% CI, 0.64-0.69) and had a rural practice (OR, 0.53; 95% CI, 0.51-0.55) and if the patient was a woman and older and had a diagnosis of HYP alone. The participation of family physicians in the QS reduced the hospitalization risk (OR, 0.9; 95% CI, 0.88-0.94) as well as the number of hospitalizations for the patients with HYP (OR, 0.93; 95% CI, 0.87-0.99).


CONCLUSIONS
The implementation of the QS in primary healthcare reduces the load in specialized medical care. A more detailed analysis of the effect of the QS on the workload and the organization of family practice as well as on the patients' morbidity and satisfaction could be done in the near future.
Department of Family Medicine, University of Tartu, Puusepa 1a, Tartu, Estonia. ruth.kalda@ut.ee.
Ruth
R
Kalda
Katrin
K
Västra
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018660:Blood Pressure Monitoring, Ambulatory; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D000075222:Essential Hypertension; D004957:Estonia; D005194:Family Practice; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000175:diagnosis*; D008297:Male; D008875:Middle Aged; D009819:Office Visits / Q000706:statistics & numerical data*; D010821:Physicians, Family / Q000592:standards*; D011320:Primary Health Care; D011786:Quality Control; D012189:Retrospective Studies; D055815:Young Adult