title: What determines inclusion in the early phase of the type 2 diabetes care trajectory in Belgium?
abstract: BACKGROUND
  In 2009, the Belgian National Institute of Health and Disability Insurance established a care trajectory (CT) for a subgroup of type 2 diabetes mellitus patients (T2DM) based on Wagner's chronic care model. The goal of this CT is to optimise the quality of care using an integrated multidisciplinary approach. This study aims to identify patient-related factors associated with inclusion in a CT and to determine the most frequent reasons for non-inclusion.
  
  
  METHODS
  In 2010, the Belgian Sentinel Network of General Practices conducted a prevalence study of type 2 diabetes. The surveillance study carried out by this nationwide, representative network collected unique information about eligibility for the CT, inclusion in the CT and reasons for non-inclusion. Based on the official inclusion and exclusion criteria, we first identified a group of eligible patients. Within this group, we then calculated the proportion of patients included in a CT as well as the prevalence of reasons for non-inclusion as reported by GPs. Furthermore, bivariate associations between patient-level parameters and inclusion were analysed. Finally, any patient-level parameters found to be statistically significant were included in a multivariate logistic regression model.
  
  
  RESULTS
  The 2010 study recorded 4600 Belgian type 2 diabetes patients. According to the official criteria, 589 patients were eligible for inclusion in a CT T2DM. By the end of August 2011, 95 patients had been included in a CT T2DM. Our findings reveal that the younger the eligible patient was, the more likely he or she was to be included in a CT. Patients living in Flanders were more likely to be included in the CT than were patients living in Wallonia. Motivated patients with specific plans to change their diets were also more likely to be included in a CT. The two most frequently reported reasons for non-inclusion were participation in another diabetes care programme and the timing of this surveillance study (inclusion will take place in the near future).
  
  
  CONCLUSIONS
  Eligible diabetes patients who were admitted to a CT T2DM during the early phases of CT implementation were mainly found to be those who are able to make progress in their disease trajectories. In the future, more attention could be paid to also include more high-risk patients.
authors.affiliation: Scientific Institute of Public Health, Health Services Research Unit, Brussels, Belgium.
authors.forename: Katrien
authors.initials: K
authors.lastname: Vanthomme
authors.affiliation: Scientific Institute of Public Health, Health Services Research Unit, Brussels, Belgium.
authors.forename: Nathalie
authors.initials: N
authors.lastname: Bossuyt
authors.affiliation: Scientific Institute of Public Health, Health Services Research Unit, Brussels, Belgium.
authors.forename: Sarah
authors.initials: S
authors.lastname: Moreels
authors.affiliation: Scientific Institute of Public Health, Health Services Research Unit, Brussels, Belgium.
authors.forename: Nicole
authors.initials: N
authors.lastname: Boffin
authors.affiliation: Université Catholique de Louvain, Institut de Recherche Santé et Société (IRSS), Brussels, Belgium.
authors.forename: Etienne
authors.initials: E
authors.lastname: De Clercq
authors.affiliation: Katholieke Universiteit Leuven, Leuven, Belgium.
authors.forename: Geert
authors.initials: G
authors.lastname: Goderis
authors.affiliation: Scientific Institute of Public Health, Health Services Research Unit, Brussels, Belgium.
authors.forename: Viviane
authors.initials: V
authors.lastname: Van Casteren
keywords: Chronic care; Family practice; Health services research; Sentinel surveillance; Type 2 diabetes mellitus