Tahrani Abd A, McCarthy Mary, Godson Jojo, Taylor Sarah, Slater Helen, Capps Nigel, Moulik Probal, Macleod Andrew F
Division of Medical Sciences, University of Birmingham and Birmingham Heartlands Hospital, Birmingham.
Br J Gen Pract. 2008 Aug;58(553):576-9. doi: 10.3399/bjgp08X319729.
General practice characteristics are important for healthcare providers to maximise outcomes. Although different aspects of general practice characteristics have been studied previously, the impact of practice size on the delivery of care has been sparsely studied, particularly in relation to diabetes care. This brief report presents a longitudinal study in Shropshire (66 practices, 16,858 patients with diabetes) to assess the impact of practice size on diabetes care before and after implementation of the Quality and Outcomes Framework (QOF). Achievement of glycaemic control targets was better before the QOF for larger as compared to smaller practices (P=0.02 and P=0.003 for haemoglobin A1c [HbA1c]<or=7.4% and 10% respectively). This difference disappeared following QOF implementation. Repeated measures analysis showed significant improvement in achieving glycaemic control targets following QOF implementation in both large and small practices (P<0.001 for HbA1c<or=7.4% and 10%). The study failed to reveal an impact of practice size on achieving the HbA1c target<or=7.4% (P=0.1) by this analysis. However, it did show an impact on reaching the target of HbA1c<10% (P=0.04) in favour of smaller practices. There was a significant difference in favour of smaller practices for achievement of prescription of angiotensin-converting enzyme inhibitors (P=0.001).
全科医疗特征对于医疗服务提供者实现最佳治疗效果非常重要。尽管此前已经对全科医疗特征的不同方面进行了研究，但诊所规模对医疗服务提供的影响却鲜有研究，尤其是在糖尿病护理方面。本简要报告介绍了在什罗普郡进行的一项纵向研究（66家诊所，16858名糖尿病患者），以评估在实施质量与结果框架（QOF）前后诊所规模对糖尿病护理的影响。与规模较小的诊所相比，在QOF实施之前，规模较大的诊所实现血糖控制目标的情况更好（糖化血红蛋白[HbA1c]≤7.4%和≤10%时，P分别为0.02和0.003）。QOF实施后，这种差异消失了。重复测量分析表明，在QOF实施后，无论大诊所还是小诊所，实现血糖控制目标均有显著改善（HbA1c≤7.4%和≤10%时，P均<0.001）。通过该分析，研究未能揭示诊所规模对实现HbA1c≤7.4%目标的影响（P=0.1）。然而，研究确实表明，在实现HbA1c<10%的目标方面，规模较小的诊所有影响（P=0.04）。在开具血管紧张素转换酶抑制剂处方的达成情况上，规模较小的诊所具有显著优势（P=0.001）。
