title: The impact of travel distance, travel time and waiting time on health-related quality of life of diabetes patients: An investigation in six European countries.
abstract: OBJECTIVE
  The effects of travel distance and travel time to the primary diabetes care provider and waiting time in the practice on health-related quality of life (HRQoL) of patients with type 2 diabetes are investigated.
  
  
  METHODS
  Survey data of 1313 persons with type 2 diabetes from six regions in England (274), Finland (163), Germany (254), Greece (165), the Netherlands (354), and Spain (103) were analyzed. Various multiple linear regression analyses with four different EQ-5D-3L indices (English, German, Dutch and Spanish index) as target variables, with travel distance, travel time, and waiting time in the practice as focal predictors and with control for study region, patient's gender, patient's age, patient's education, time since diagnosis, thoroughness of provider-patient communication were computed. Interactions of regions with the remaining five control variables and the three focal predictors were also tested.
  
  
  RESULTS
  There are no interactions of regions with control variables or focal predictors. The indices decrease with increasing travel time to the provider and increasing waiting time in the provider's practice.
  
  
  CONCLUSIONS
  HRQoL of patients with type 2 diabetes might be improved by decreasing travel time to the provider and waiting time in the provider's practice.
authors.affiliation: Trimberg Research Academy, University of Bamberg, D-96045 Bamberg, Germany. Electronic address: uwe.konerding@uni-bamberg.de.
authors.forename: Uwe
authors.initials: U
authors.lastname: Konerding
authors.affiliation: The Balance of Care Group, 39a Cleveland Road, London N1 3ES, UK. Electronic address: tom.bowen@btinternet.com.
authors.forename: Tom
authors.initials: T
authors.lastname: Bowen
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: elkhuizen@bmg.eur.nl.
authors.forename: Sylvia G
authors.initials: SG
authors.lastname: Elkhuizen
authors.affiliation: REDISSEC and Joint Research Unit in Biomedical Engineering (IIS La Fe-Universitat Politècnica de València), Bulevar sur s/n, 46026 Valencia, Spain. Electronic address: rfaubel@itaca.upv.es.
authors.forename: Raquel
authors.initials: R
authors.lastname: Faubel
authors.affiliation: The Balance of Care Group, 39a Cleveland Road, London N1 3ES, UK. Electronic address: paul.forte@balanceofcare.com.
authors.forename: Paul
authors.initials: P
authors.lastname: Forte
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21 Athens, Greece. Electronic address: ekarabli@esdy.edu.gr.
authors.forename: Eleftheria
authors.initials: E
authors.lastname: Karampli
authors.affiliation: Institute of Health Policy & Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands. Electronic address: mahdavi@bmg.eur.nl.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Mahdavi
authors.affiliation: Aalto University, Department of Industrial Engineering and Management, PO Box 15500, Aalto 00076, Espoo, Finland. Electronic address: tomi.malmstrom@aalto.fi.
authors.forename: Tomi
authors.initials: T
authors.lastname: Malmström
authors.affiliation: Department of Health Economics, National School of Public Health, 196 Alexandras Ave., 115 21 Athens, Greece. Electronic address: epavi@esdy.edu.gr.
authors.forename: Elpida
authors.initials: E
authors.lastname: Pavi
authors.affiliation: Aalto University, Department of Industrial Engineering and Management, PO Box 15500, Aalto 00076, Espoo, Finland. Electronic address: paulus.torkki@aalto.fi.
authors.forename: Paulus
authors.initials: P
authors.lastname: Torkki
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000628:therapy*; D004739:England / Q000453:epidemiology; D005060:Europe / Q000453:epidemiology; D005260:Female; D005387:Finland / Q000453:epidemiology; D005858:Germany / Q000453:epidemiology; D006115:Greece / Q000453:epidemiology; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D011788:Quality of Life; D013030:Spain / Q000453:epidemiology; D011795:Surveys and Questionnaires; D013997:Time Factors; D014195:Travel; D014850:Waiting Lists
keywords: EQ-5D; Health-related quality of life; Travel distance to provider; Travel time to provider; Type 2 diabetes mellitus; Waiting time in provider’s practice