Patient and General Practitioner characteristics influencing the management of non-insulin-treated diabetes mellitus: A cross-sectional study in Italy.
OBJECTIVE
We assessed the influence of patient and General Practitioner (GP) characteristics on the adherence to process of care indicators for non-insulin-treated type 2 diabetes management in the Veneto Region (northeastern Italy).


METHODS
Among non-insulin-treated diabetic patients aged 18-84years identified by multiple information sources, we assessed the measurement of glycated hemoglobin, microalbumin, and lipids through the year 2013. Patients' variables included gender, age, citizenship, and the attendance to Diabetes Clinics, while GP characteristics were gender, age and an attitude score derived from a questionnaire. The influence of patient and GP variables were investigated through multilevel regression with the execution of two HbA1c tests in 2013 as the outcome.


RESULTS
Out of 139,935 study subjects, more than 70% had at least one HbA1c test in 2013; this percentage decreased to about 40% for two HbA1c examinations. 67% of patients had an assessment of lipid profile, while 45% underwent a microalbumin test. These percentages were lower for immigrant patients and increased with age until the 65-74years age class. Patients attending Diabetes Clinics were usually better monitored than those who did not. In this latter group, female gender (risk ratio 1.08, 1.02-1.14), younger age (risk ratio 1.15, 1.06-1.25) and high attitude score of GPs (risk ratio 1.20, 1.13-1.27) were associated with a better management.


CONCLUSIONS
Both patient and GP variables influence the adherence to process of care indicators. The implementation of effective strategies of disease management at the primary care level may improve the control of glycemic and cardiovascular risk factors.
Epidemiological Department, Veneto Region, Italy.
Eliana
E
Ferroni
Epidemiological Department, Veneto Region, Italy.
Veronica
V
Casotto
Epidemiological Department, Veneto Region, Italy.
Mara
M
Pigato
Pharmaceutical Department, Veneto Region, Italy.
Giovanna
G
Scroccaro
Division of Health Care Planning and Evaluation, Veneto Region, Italy.
Maria Chiara
MC
Corti
Epidemiological Department, Veneto Region, Italy.
Ugo
U
Fedeli
Epidemiological Department, Veneto Region, Italy.
Mario
M
Saugo
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy*; D019468:Disease Management; D005260:Female; D058005:General Practitioners; D006801:Humans; D007558:Italy; D008297:Male; D008875:Middle Aged; D010361:Patients; D011320:Primary Health Care / Q000706:statistics & numerical data; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
Diabetes mellitus; Patient characteristics; Process of care indicators