title: Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes.
abstract: BACKGROUND
  Little is known about the impact of a general practitioner management plan (GPMP) on health outcomes of patients with diabetes.
  
  
  OBJECTIVE
  To examine the impact of a GPMP on the risk of hospitalisation for diabetes.
  
  
  METHODS
  A retrospective study using administrative data from the Australian Government Department of Veterans' Affairs was conducted (1 July 2006 to 30 June 2014) of diabetes patients either exposed or unexposed to a GPMP. The primary end-point was the risk of first hospitalisation for a diabetes-related complication and was assessed using Cox proportional hazard regression models with death as a competing risk. Secondary end-points included rates of receiving guideline care for diabetes, with differences assessed using Poisson regression analyses.
  
  
  RESULTS
  A total of 16 214 patients with diabetes were included; 8091 had a GPMP, and 8123 did not. After 1 year, 545 (6.7%) patients with a GPMP and 634 (7.8%) of patients without a GPMP were hospitalised for a diabetes complication. There was a 22% reduction in the risk of being hospitalised for a diabetes complication (adjusted hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.69-0.87, P < 0.0001) for those who received a GPMP by comparison to those who did not. Increased rates of diabetes guideline care, HbA1c claims (adjusted HR 1.29, 95% CI 1.25-1.33) and microalbuminura claims (adjusted HR 1.65, 95% CI 1.58-1.72) were observed after a GPMP.
  
  
  CONCLUSIONS
  Provision of a GPMP in older patients with diabetes resulted in improved health outcomes, delaying the risk of hospitalisation at 12 months for diabetes complications. GPMP should be included as part of routine primary care for older patients with diabetes.
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: G E
authors.initials: GE
authors.lastname: Caughey
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: A I
authors.initials: AI
authors.lastname: Vitry
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: E N
authors.initials: EN
authors.lastname: Ramsay
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: A L
authors.initials: AL
authors.lastname: Gilbert
authors.affiliation: Clinical Pharmacology, Royal Adelaide Hospital, Adelaide, South Australia, Australia.|Discipline of Clinical Pharmacology, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: S
authors.initials: S
authors.lastname: Shakib
authors.affiliation: School of Public Health, University of Adelaide, Adelaide, South Australia, Australia.
authors.forename: P
authors.initials: P
authors.lastname: Ryan
authors.affiliation: Sansom Institute of Health Service Research and School of Nursing and Midwifery, University of South Australia, Adelaide, South Australia, Australia.|Centre for Research Excellence in Chronic Disease Prevention, The Cairns Institute, James Cook University, Cairns, Queensland, Australia.
authors.forename: A
authors.initials: A
authors.lastname: Esterman
authors.affiliation: School of Population Health, University of South Australia, Adelaide, South Australia, Australia.|Centre for Chronic Disease Prevention, Australian Institute of Tropical Health and Medicine, College of Public Health, Medical and Veterinary Sciences, James Cook University, Cairns, Queensland, Australia.
authors.forename: R A
authors.initials: RA
authors.lastname: McDermott
authors.affiliation: Quality Use of Medicines and Pharmacy Research Centre, School of Pharmacy and Medical Sciences, Sansom Institute of Health Sciences, University of South Australia, Adelaide, South Australia, Australia.
authors.forename: E E
authors.initials: EE
authors.lastname: Roughead
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001315:Australia / Q000453:epidemiology; D048909:Diabetes Complications / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D058005:General Practitioners; D006760:Hospitalization; D006801:Humans; D008297:Male; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care / Q000379:methods; D012017:Referral and Consultation / Q000706:statistics & numerical data*; D012189:Retrospective Studies
keywords: care plan; diabetes; general practice; hospitalisation