Fagot-Campagna Anne, Romon Isabelle, Poutignat Nathalie, Bloch Juliette
Institut de veille sanitaire, département des maladies chroniques et traumatismes, 94415 Saint-Maurice.
Rev Prat. 2007 Dec 31;57(20):2209-16.
We studied the relationship between 100% medical fee coverage for chronic disease and quality of care in people with type 2 diabetes treated with oral hypoglycaemic agents (OHA) only, in France.
For the Entred study, 10,000 adults who received reimbursements for a delivery of OHA or insulin were randomly sampled from the database of the major national medical insurance system in 2001. For these 10,000 people, we extracted all medical consumption from the 2001 database and mailed a medical questionnaire; another questionnaire was mailed to their medical provider. We restricted the analysis to people with type 2 diabetes, treated with OHA only, with no annual visit to an endocrinologist (n = 1167), and to a sub-group with no complication reported by their medical provider (n = 525).
71% of people benefited from a waiver of co-payment due to a chronic disease (100% medical fee coverage for a list of 30 diseases including diabetes). People with 100% coverage were more likely to be women, older, with a longer duration of the disease, more often on several OHA and a drug for cardiovascular disease, and had a higher level of HbA1c. In multivariate analyses, 100% fee coverage was linked with a higher frequency of three HbA1c measurements (OR = 2,5 [1,6-4,0]), one electrocardiogram (1,9 [1,2-3,1]) and one podiatric visit (2,2 [1,1-4,3]) in 2001 in people without complications. No association was found with one measurement of albuminuria, creatininemia, lipids, and ophtalmological, dental or dietitian visit.
In 2001, a significant relationship was found between 100% medical fee coverage on a better quality of care for people with diabetes on OHA at an early stage of the disease. Several explanations are further discussed.
在法国，我们研究了仅接受口服降糖药（OHA）治疗的2型糖尿病患者中，慢性病100%医疗费用覆盖与医疗质量之间的关系。
对于Entred研究，2001年从主要国家医疗保险系统数据库中随机抽取了10000名接受OHA或胰岛素报销的成年人。对于这10000人，我们从2001年数据库中提取了所有医疗消费信息，并邮寄了一份医疗问卷；另一份问卷则邮寄给他们的医疗服务提供者。我们将分析限制在仅接受OHA治疗、每年未就诊于内分泌科医生的2型糖尿病患者（n = 1167），以及医疗服务提供者报告无并发症的亚组（n = 525）。
71%的人因慢性病而受益于共付费用豁免（对包括糖尿病在内的30种疾病清单提供100%医疗费用覆盖）。100%覆盖的人群更可能是女性、年龄较大、病程较长、更常使用多种OHA和一种心血管疾病药物，且糖化血红蛋白（HbA1c）水平较高。在多变量分析中，2001年，在无并发症的人群中，100%费用覆盖与更高频率的三次HbA1c测量（比值比[OR]=2.5[1.6 - 4.0]）、一次心电图检查（1.9[1.2 - 3.1]）和一次足病科就诊（2.2[1.1 - 4.3]）相关。未发现与一次蛋白尿、血肌酐、血脂测量以及眼科、牙科或营养师就诊存在关联。
2001年，在疾病早期仅接受OHA治疗的糖尿病患者中，发现100%医疗费用覆盖与更好的医疗质量之间存在显著关系。进一步讨论了几种解释。
