Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy.
Diabetes Care. 2009 Nov;32(11):1986-92. doi: 10.2337/dc09-0647. Epub 2009 Aug 12.
To investigate the role of clinical and socioeconomic variables as determinants of adherence to recommended diabetes care guidelines and assess differences in the process of care between diabetologists and general practitioners.
We identified diabetic residents in Torino, Italy, as of 31 July 2003, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations registered during the subsequent 12 months and performed regression analyses to identify associations with quality-of-care indicators based on existing guidelines.
After 1 year, only 35.8% of patients had undergone a comprehensive assessment. In the multivariate models, factors independently and significantly associated with lower quality of care were age >or=75 years (prevalence rate ratio [PRR] 0.66 [95% CI 0.61-0.70]) and established cardiovascular disease (0.89 [0.86-0.93]). Disease severity (PRR for insulin-treated patients 1.45 [1.38-1.53]) and diabetologist consultation (PRR 3.34 [3.17-3.53]) were positively associated with high quality of care. No clear association emerged between sex and socioeconomic status. These differences were strongly reduced in patients receiving diabetologist care compared with patients receiving general practitioner care only.
Despite widespread availability of guidelines and simple screening procedures, a nonnegligible portion of the diabetic population, namely elderly individuals and patients with less severe forms of the disease, are not properly cared for. As practitioners in diabetes centers are more likely to adhere to guidelines than general practitioners, quality in the diabetes care process can be improved by increasing the intensity of disease management programs, with greater participation by general practitioners.
研究临床和社会经济学变量在决定患者是否遵循推荐的糖尿病治疗指南方面的作用，并评估专科医生（如糖尿病专家）和全科医生（如家庭医生）在治疗过程中的差异。
我们利用多个独立的数据来源，于 2003 年 7 月 31 日之前确定了意大利都灵的糖尿病居民。我们收集了此后 12 个月内的多项实验室检查和专科医学检查的数据，并进行回归分析，根据现有指南确定与质量控制指标相关的因素。
1 年后，仅有 35.8%的患者接受了全面评估。在多变量模型中，与较差的治疗质量独立且显著相关的因素为年龄≥75 岁（流行率比值[PRR]0.66[95%CI0.61-0.70]）和已确诊的心血管疾病（0.89[0.86-0.93]）。疾病严重程度（胰岛素治疗患者的 PRR 为 1.45[1.38-1.53]）和专科医生咨询（PRR 为 3.34[3.17-3.53]）与高质量的治疗呈正相关。性别和社会经济地位与治疗质量之间没有明确的关联。与仅接受全科医生治疗的患者相比，接受糖尿病专科医生治疗的患者之间的这些差异明显减少。
尽管有广泛的指南和简单的筛选程序，但相当一部分糖尿病患者（即老年患者和病情较轻的患者）没有得到妥善治疗。由于糖尿病中心的医生比全科医生更有可能遵循指南，因此可以通过增加疾病管理项目的强度，让全科医生更多地参与，来改善糖尿病治疗过程的质量。
