title: Exploring the determinants of endocrinologist visits by patients with diabetes.
abstract: BACKGROUND
  Diabetes is today a major public health concern in terms of its financial and social burden. Previous studies have revealed that specialist care for patients with diabetes leads to more positive outcomes than care by general practitioners (GPs) alone. The aim of this study was to estimate the determinants of endocrinologist consultation by patients with diabetes.
  
  
  METHODS
  We used a two-part model to explore both the decision to consult and the frequency of consultations. We used claim data collected for 65,633 affiliates of a French social security provider. Patients were aged over 18 and treated for diabetes (types I and II). We controlled for patients' socioeconomic characteristics, type of diabetes treatment, medical care, and health status. We also controlled for variables, such as the cost of a visit, the distance to the nearest endocrinologist's office, the density of medical practitioners and the prevalence of diabetes in the area.
  
  
  RESULTS
  The results show that the parameters associated with the decision to consult an endocrinologist were considerably different from factors associated with the frequency of consultations. A marked positive effect of income on the decision to consult was found, whereas travel time to the office had a negative impact on both the decision to consult and the frequency of consultations. Increasing treatment complexity is associated with a higher probability of consulting an endocrinologist. We found evidence of a significant substitution effect between GPs and endocrinologists. Finally, consultation price is a barrier to seeing an endocrinologist.
  
  
  CONCLUSIONS
  Given that financial barriers were identified in the relatively wealthy population analysed here, it is likely that this may be even more of an obstacle in the general population.
authors.affiliation: MGEN Foundation for Public Health, 3 square Max Hymans, 75748, Paris Cedex 15, France.|LIRAES (EA 4470), University of Paris Descartes, 12 rue de l'École de médecine, 75270, Paris Cedex 06, France.
authors.forename: Luiz Flavio
authors.initials: LF
authors.lastname: Andrade
authors.affiliation: LIRAES (EA 4470), University of Paris Descartes, 12 rue de l'École de médecine, 75270, Paris Cedex 06, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Rapp
authors.affiliation: MGEN Foundation for Public Health, 3 square Max Hymans, 75748, Paris Cedex 15, France. csevilla@mgen.fr.
authors.forename: Christine
authors.initials: C
authors.lastname: Sevilla-Dedieu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003922:Diabetes Mellitus, Type 1 / Q000188:drug therapy / Q000191:economics* / Q000523:psychology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy / Q000191:economics* / Q000523:psychology / Q000628:therapy; D000072097:Endocrinologists / Q000191:economics / Q000523:psychology; D005260:Female; D005602:France; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D007344:Insurance Claim Reporting; D008297:Male; D008875:Middle Aged; D012017:Referral and Consultation / Q000191:economics*; D012044:Regression Analysis; D012720:Severity of Illness Index; D012959:Socioeconomic Factors
chemical_list: D007004:Hypoglycemic Agents; D007328:Insulin
keywords: Count data; Diabetes management; Health costs