title: The impact of primary care organization on avoidable hospital admissions for diabetes in 23 countries.
abstract: OBJECTIVE
  Diabetes is a so-called ambulatory care sensitive condition. It is assumed that by appropriate and timely primary care, hospital admissions for complications of such conditions can be avoided. This study examines whether differences between countries in diabetes-related hospitalization rates can be attributed to differences in the organization of primary care in these countries.
  
  
  METHODS
  Data on characteristics of primary care systems were obtained from the QUALICOPC study that includes surveys held among general practitioners and their patients in 34 countries. Data on avoidable hospitalizations were obtained from the OECD Health Care Quality Indicator project. Negative binomial regressions were carried out to investigate the association between characteristics of primary care and diabetes-related hospitalizations.
  
  
  METHODS
  A total of 23 countries.
  
  
  METHODS
  General practitioners and patients.
  
  
  METHODS
  Diabetes-related avoidable hospitalizations.
  
  
  RESULTS
  Continuity of care was associated with lower rates of diabetes-related hospitalization. Broader task profiles for general practitioners and more medical equipment in general practice were associated with higher rates of admissions for uncontrolled diabetes. Countries where patients perceive better access to care had higher rates of hospital admissions for long-term diabetes complications. There was no association between disease management programmes and rates of diabetes-related hospitalization. Hospital bed supply was strongly associated with admission rates for uncontrolled diabetes and long-term complications.
  
  
  CONCLUSIONS
  Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related hospitalizations. Hospital bed supply appeared to be a very important factor in this relationship. Apparently, it takes more than strong primary care to avoid hospitalizations.
  
  
  CONCLUSIONS
  Countries with elements of strong primary care do not necessarily have lower rates of diabetes-related avoidable hospitalization. Hospital bed supply is strongly associated with admission rates for uncontrolled diabetes and long-term complications. Continuity of care was associated with lower rates of diabetes-related hospitalization. Better access to care, broader task profiles for general practitioners, and more medical equipment in general practice was associated with higher rates of admissions for diabetes.
authors: a Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands ;|b National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands ;
authors: Tessa
authors: T
authors: Van Loenen
authors: a Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands ;
authors: Marjan J
authors: MJ
authors: Faber
authors: a Radboud University Medical Center, Radboud Institute for Health Sciences, IQ Healthcare , Nijmegen , The Netherlands ;
authors: Gert P
authors: GP
authors: Westert
authors: b National Institute for Public Health and the Environment (RIVM) , Bilthoven , The Netherlands ;|c Department of Social Medicine , Academic Medical Center , Amsterdam , The Netherlands.
authors: Michael J
authors: MJ
authors: Van den Berg
mesh_terms: D001513:Beds / Q000600:supply & distribution; D003266:Continuity of Patient Care; D003431:Cross-Cultural Comparison; D048909:Diabetes Complications / Q000628:therapy; D003920:Diabetes Mellitus / Q000628:therapy*; D019468:Disease Management; D004864:Equipment and Supplies / Q000600:supply & distribution; D005260:Female; D058006:General Practice; D058005:General Practitioners; D014943:Global Health; D006295:Health Resources / Q000600:supply & distribution*; D006297:Health Services Accessibility; D006760:Hospitalization; D006801:Humans; D008297:Male; D010343:Patient Admission; D011320:Primary Health Care / Q000458:organization & administration*; D012044:Regression Analysis
keywords: Avoidable hospitalization; The Netherlands; diabetes; general practice; health services research; primary care