Abstract
Aim
The aim of this observational study was to assess mortality of patients with type
2 diabetes by type of healthcare delivery system, i.e. through specialist centers
or generalist doctors, or integrated care.
Methods
The study was conducted at the “Vicentino Ovest” Local Health District in the Veneto
Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with
diabetes (≥20 years old) were identified using different public health databases.
They were grouped as: patients followed up by specialists at diabetes clinics (DS);
patients seen only by their own general practitioner (GP); and patients receiving
integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard
ratios for available potential predictors of death by level of care.
Results
The crude mortality rate was highest in the GP group (26.1 per 1000 person-years),
the difference being minimal when compared with the DS group (21.7 per 1000 person-years)
and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients
followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the
DS-GP group.
Conclusions
The findings of the present study could demonstrate that it is safe and cost-effective,
after a first specialist assessment at a diabetes service, for low-risk diabetic patients
to be managed by family physicians as part of a coordinated care approach, based on
the specialist's clinical recommendations; GPs can subsequently refer patients to
a specialist whenever warranted by their clinical condition.
Keywords
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Article info
Publication history
Published online: April 17, 2014
Accepted:
March 19,
2014
Received in revised form:
March 13,
2014
Received:
September 25,
2013
Identification
Copyright
© 2014 Primary Care Diabetes Europe. Published by Elsevier Inc. All rights reserved.
