title: Membership in a diabetes-care network and adherence to clinical practice guidelines for treating type 2 diabetes among general practitioners: A four-year follow-up.
abstract: To assess whether private general practitioners (GPs) belonging to a diabetes-care network adhered more closely to clinical practice guidelines for diabetes care than GPs not in such a network, for all their patients with type 2 diabetes treated with medication (patients with diabetes), regardless of whether they received care through a network (that is, whether a halo effect occurred).
  
  
  
  The study, based on health insurance reimbursement databases in southeastern France, included 468 GPs in two networks and 468 non-network GPs in the same geographical area, matched one-to-one by propensity scores. We followed up their patients with diabetes (n=22,808) from 2008 through 2011, conducting multivariate time-to-event analyses (Cox models) that took the matching design into account to evaluate time from inclusion until performance of the given number of each of six recommended examinations/tests.
  
  
  
  GPs belonging to a diabetes-care network adhered more closely to clinical practice guidelines but our result were slightly pronounced. Hazard ratios (HR) were significantly higher for patients of network GPs for the implementation of 3 HbA1C assays (HRa=1.13; [95%CI=1.10-1.16]), or 1 microalbuminuria assay (1.4 [1.35-1.45]); they were lower for LDL-cholesterol assays (1.04 [1.01-1.07]) and ophthalmological checkups (1.07 [1.04-1.10]), and not significant for creatinemia or cardiac monitoring.
  
  
  
  Network GPs had better diabetes monitoring practices for all their patients with diabetes than the other GPs, especially for the most diabetes-specific tests. Further research is needed in other settings to confirm the existence of this halo effect.
authors.affiliation: ORS PACA, Southeastern Health Regional Observatory, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; Aix Marseille University, Department of General Practice, Marseille, France. Electronic address: ludovic.casanova@inserm.fr.
authors.forename: Ludovic
authors.initials: L
authors.lastname: Casanova
authors.affiliation: ORS PACA, Southeastern Health Regional Observatory, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; Aix Marseille University, Department of General Practice, Marseille, France.
authors.forename: Aurélie
authors.initials: A
authors.lastname: Bocquier
authors.affiliation: ORS PACA, Southeastern Health Regional Observatory, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; Aix Marseille University, Department of General Practice, Marseille, France.
authors.forename: Sébastien
authors.initials: S
authors.lastname: Cortaredona
authors.affiliation: Agence régionale de santé PACA (Regional Health Agency), Department of Studies and Observation, Marseille, France.
authors.forename: Stève
authors.initials: S
authors.lastname: Nauleau
authors.affiliation: Agence régionale de santé PACA (Regional Health Agency), Department of Studies and Observation, Marseille, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Sauze
authors.affiliation: Direction Régionale du Service Médical de l'Assurance Maladie Provence-Alpes-Côte d'Azur et Corse (CNAMTS), France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Sciortino
authors.affiliation: Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France.
authors.forename: Patrick
authors.initials: P
authors.lastname: Villani
authors.affiliation: ORS PACA, Southeastern Health Regional Observatory, Marseille, France; Aix Marseille Univ, INSERM, IRD, SESSTIM, Economics and Social Sciences Applied to Health & Analysis of Medical Information, Marseille, France; Aix Marseille University, Department of General Practice, Marseille, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Verger
mesh_terms: D000067575:Administrative Claims, Healthcare; D000293:Adolescent; D000328:Adult; D000368:Aged; D019058:Community Networks / Q000639:trends*; D016208:Databases, Factual; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D005602:France; D058005:General Practitioners / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards*; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic / Q000592:standards*; D010818:Practice Patterns, Physicians' / Q000592:standards*; D017149:Private Sector / Q000639:trends; D017064:Process Assessment, Health Care / Q000592:standards*; D057216:Propensity Score; D016016:Proportional Hazards Models; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D007004:Hypoglycemic Agents
keywords: Community networks; Diabetes mellitus; Disease management; General practice; Multilevel analysis