Modeling patients’ choice between a primary care physician or a diabetes specialist for the management of type-2 diabetes using a bivariate probit analysis

Published:August 04, 2020DOI:https://doi.org/10.1016/j.pcd.2020.07.010

      Highlights

      • A preference for primary care physicians over diabetes specialists was found.
      • Family history of diabetes in siblings was associated with choosing a specialist.
      • Regular diabetic retinopathy screening was associated with choosing a specialist.
      • Younger age and female sex, were predictors for choosing a diabetes specialist.
      • Higher HbA1c and experience of hypoglycemia predicted the choice of a specialist.

      Abstract

      Aims

      To determine the prevalence of type-2 diabetes patients that were initially and currently being treated by primary care physicians (PCPs) or diabetes specialists and assess predictors influencing their choice.

      Methods

      This cross-sectional study was conducted in nine Greek primary healthcare units. Patients’ choices were modeled using a bivariate probit analysis.

      Results

      A total of 225 patients participated (84% response rate). Only 15.9% and 11.9% of the respondents acknowledged having chosen a diabetes specialist for their initial or current treatment, respectively. The family history of diabetes in siblings and the screening for diabetic retinopathy during the past year were significantly positively associated with choosing a diabetes specialist (initially p = 0.033 or currently p = 0.007), and resulted in a statistically significant reduction of the joint probabilities of choosing a PCP by 15.6% and 13.6%, respectively. Younger age (p = 0.040), female sex (p = 0.017), higher HbA1c (p = 0.004), experience of hypoglycemia (p = 0.029) and low cardiovascular morbidity index (p = 0.016) emerged as important predictors for choosing a diabetes specialist for their treatment.

      Conclusions

      Our findings provide a better insight in diabetes patients’ choices regarding the category of their treating physicians and their predictors. More studies are required to replicate them and identify patient subpopulations that may favor diabetes specialists’ guidance.

      Keywords

      To read this article in full you will need to make a payment

      Subscribe:

      Subscribe to Primary Care Diabetes
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • American Diabetes Association
        Standards of medical care in diabetes – 2020.
        Diabetes Care. 2020; 43: S1-S2
        • International Diabetes Federation
        IDF Diabetes Atlas.
        9th ed. International Diabetes Federation, Brussels, Belgium2019
        • Liatis S.
        • Dafoulas G.E.
        • Kani C.
        • et al.
        The prevalence and treatment patterns of diabetes in the Greek population based on real-world data from the nation-wide prescription database.
        Diabetes Res. Clin. Pract. 2016; 118: 162-167
        • International Diabetes Federation
        Diabetes Complications.
        2020 (Available at: https://www.idf.org/aboutdiabetes/complications.html (accessed 05.02.20))
        • Rushforth B.
        • McCrorie C.
        • Glidewell L.
        • et al.
        Barriers to effective management of type 2 diabetes in primary care: qualitative systematic review.
        Br. J. Gen. Pract. 2016; 66: e114-e127
        • American Diabetes Association
        Standards of medical care in diabetes – 2020 abridged for primary care providers.
        Clin. Diabetes. 2020; 38: 10-38
        • Shrivastav M.
        • Gibson Jr., W.
        • Shrivastav R.
        • et al.
        Type 2 diabetes management in primary care: the role of retrospective, professional continuous glucose monitoring.
        Diabetes Spectr. 2018; 31: 279-287
        • Britt H.
        • Miller G.
        • Charles J.
        • et al.
        General Practice Activity in Australia 2009–10. General Practice Series No. 27. Cat. No. GEP 27.
        Australian Institute of Health and Welfare, Canberra2010
        • Jaakkimainen L.
        • Upshur R.
        • Klein-Geltink J.E.
        • et al.
        Primary Care in Ontario: ICES Atlas.
        Institute for Clinical Evaluative Sciences, Toronto2006
        • Griffin S.
        • Kinmonth A.L.
        Diabetes care: the effectiveness of systems for routine surveillance for people with diabetes.
        Cochrane Database Syst. Rev. 2000; 2: CD000541
        • Arai K.
        • Hirao K.
        • Matsuba I.
        • et al.
        The status of glycemic control by general practitioners and specialists for diabetes in Japan: a cross-sectional survey of 15,652 patients with diabetes mellitus.
        Diabetes Res. Clin. Pract. 2009; 83: 397-401
        • Orozco-Beltran D.
        • Pan C.
        • Svendsen A.L.
        • et al.
        Basal insulin initiation in primary vs. specialist care: similar glycaemic control in two different patient populations.
        Int. J. Clin. Pract. 2016; 70: 236-243
        • Russell A.W.
        • Baxter K.A.
        • Askew D.A.
        • et al.
        Model of care for the management of complex Type 2 diabetes managed in the community by primary care physicians with specialist support: an open controlled trial.
        Diabet. Med. 2013; 30: 1112-1121
        • World Health Organization
        The World Health Report 2008: Primary Health Care (Now More Than Ever).
        2008 (Available at: https://www.who.int/whr/2008/en/ (accessed 05.02.20))
        • Morrison F.
        • Shubina M.
        • Goldberg S.I.
        • Turchin A.
        Performance of primary care physicians and other providers on key process measures in the treatment of diabetes.
        Diabetes Care. 2013; 36: 1147-1152
        • Peduzzi P.
        • Concato J.
        • Kemper E.
        • Holford T.R.
        • Feinstein A.R.
        A simulation study of the number of events per variable in logistic regression analysis.
        J. Clin. Epidemiol. 1996; 49: 1373-1379
        • Norton E.C.
        • Dowd B.E.
        Log odds and the interpretation of logit models.
        Health Serv. Res. 2018; 53: 859-878
        • Cakmakyapan S.
        • Goktas A.
        A comparison of binary logit and probit models with a simulation study.
        J. Soc. Econ. Stat. 2013; 2: 1-17
        • Maarten B.L.
        Stata tip 97: getting at ρ’s and σ’s.
        Stata J. 2011; 11: 315-317
        • Lawton J.
        • Parry O.
        • Peel E.
        • Douglas M.
        Diabetes service provision: a qualitative study of newly diagnosed Type 2 diabetes patients’ experiences and views.
        Diabet. Med. 2005; 22: 1246-1251
        • Foster M.M.
        • Mitchell G.K.
        ‘The onus is on me’: primary care patient views of Medicare-funded team care in chronic disease management in Australia.
        Health Expect. 2015; 18: 879-891
        • Tabrizi J.S.
        • Wilson A.J.
        • Coyne E.T.
        • O’Rourke P.K.
        Clients’ perspective on service quality for type 2 diabetes in Australia.
        Aust. N. Z. J. Public Health. 2007; 31: 511-515
        • Lawton J.
        • Peel E.
        • Parry O.
        • et al.
        Lay perceptions of type 2 diabetes in Scotland: bringing health services back in.
        Soc. Sci. Med. 2005; 60: 1423-1435
        • Vermaes I.P.
        • van Susante A.M.
        • van Bakel H.J.
        Psychological functioning of siblings in families of children with chronic health conditions: a meta-analysis.
        J. Pediatr. Psychol. 2012; 37: 166-184
        • Vimalananda V.G.
        • Dvorin K.
        • Fincke B.G.
        • et al.
        Patient, primary care provider, and specialist perspectives on specialty care coordination in an integrated health care system.
        J. Ambul. Care Manage. 2018; 41: 15-24
        • Fernandez-Egea E.
        • Walker R.
        • Ziauddeen H.
        • et al.
        Birth weight, family history of diabetes and diabetes onset in schizophrenia.
        BMJ Open Diabetes Res. Care. 2020; 8: e001036
        • Gonder-Frederick L.A.
        • Clarke W.L.
        • Cox D.J.
        The emotional, social, and behavioral implications of insulin-induced hypoglycemia.
        Semin. Clin. Neuropsychiatry. 1997; 2: 57-65
        • Lu S.
        • Harris M.F.
        Prevention of diabetes and heart disease – patient perceptions on risk, risk assessment and the role of their GP in preventive care.
        Aust. Fam. Physician. 2013; 42: 328-331
        • van Eijk K.N.D.
        • Blom J.W.
        • Gussekloo J.
        • et al.
        Diabetic retinopathy screening in patients with diabetes mellitus in primary care: incentives and barriers to screening attendance.
        Diabetes Res. Clin. Pract. 2012; 96: 10-16
        • Kashim R.M.
        • Newton P.
        • Ojo O.
        Diabetic retinopathy screening: a systematic review on patients’ non-attendance.
        Int. J. Environ. Res. Public Health. 2018; 15: E157
        • Bertakis K.D.
        • Azari R.
        • Helms L.J.
        • et al.
        Gender differences in the utilization of health care services.
        J. Fam. Pract. 2000; 49: 147-152
        • Cleary P.D.
        • Mechanic D.
        • Greenley J.R.
        Sex differences in medical care utilization: an empirical investigation.
        J. Health Soc. Behav. 1982; 23: 106-119
        • Hibbard J.H.
        • Pope C.R.
        Gender roles, illness orientation and use of medical services.
        Soc. Sci. Med. 1983; 17: 129-137
        • Groenewegen P.P.
        • Jurgutis A.
        A future for primary care for the Greek population.
        Qual. Prim. Care. 2013; 21: 369-378