National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country Theme 8, University of Birmingham, Birmingham, United Kingdom ; School of Health and Population Sciences, University of Birmingham, Birmingham, United Kingdom.
National Institute for Health Research (NIHR) Collaborations for Leadership in Applied Health Research and Care (CLAHRC) Birmingham and Black Country Theme 8, University of Birmingham, Birmingham, United Kingdom ; Primary Care and population Sciences, University of Southampton, Southampton, United Kingdom.
PLoS One. 2013 Dec 17;8(12):e83738. doi: 10.1371/journal.pone.0083738. eCollection 2013.
The rising challenge of diabetes requires novel service delivery approaches. In the UK, Local Enhanced Services (LES) have been commissioned for diabetes. Health professionals from general practices (GPs) who signed up to LES were given additional training (and a monetary incentive) to improve management of patients with diabetes. All practices in the PCT were invited to the LES initiative, which ensured avoiding selection bias. The aim of the study was to examine the impact of LES in terms of diabetes Quality Outcome Framework (QOF) indicators: DM23(glycaemia), DM17(lipid) and DM12(blood pressure; BP).
QOF diabetes indicators were examined using data from 76 general practices for 2009-2010 in a large primary care trust area in Birmingham, UK. Data were extracted from Quality Management Analysis System. The primary outcome was a difference in achievement of QOF indicators between LES and NLES practices. A secondary outcome was the difference between LES and non-LES practices for hospital first and follow-up appointments.
We did not find any difference for DM12(BP) and DM17(lipid) outcomes between LES and NLES practices. However, LES practices were more likely to achieve the DM23(glycaemia) outcome (estimated odds 1.459;95% CI:1.378-1.544; P=0.0001). The probability of achieving satisfactory level of DM23(glycaemia) increased by almost 10% when GPs belonged to LES groups compared with GPs in NLES group. LES practices were less likely to refer patients to secondary care.
Overall, LES practices performed better in the achievement of DM23(glycaemia) and also referred fewer patients to hospital, thereby meeting their objectives. This suggests that the LES approach is beneficial and needs to be further explored in order to ascertain whether the impact exerted was due to LES.
糖尿病发病率的不断上升对医疗服务提出了新的挑战。在英国，地方强化服务（LES）已被用于糖尿病治疗。参与 LES 的全科医生接受了额外的培训（并获得了金钱奖励），以改善糖尿病患者的管理。PCT 内的所有诊所都被邀请参与 LES 计划，以确保避免选择偏倚。本研究旨在通过 QOF 指标（DM23[血糖]、DM17[血脂]和 DM12[血压]）评估 LES 的影响。
使用英国伯明翰一个大型初级保健信托区 76 家全科诊所 2009-2010 年的数据，通过质量管理分析系统提取数据，对 QOF 糖尿病指标进行分析。主要结果是 LES 和非 LES 诊所之间在 QOF 指标达成方面的差异。次要结果是 LES 和非 LES 诊所之间在医院初次就诊和随访预约方面的差异。
我们没有发现 LES 和非 LES 诊所之间在 DM12（BP）和 DM17（血脂）结果方面存在差异。然而，LES 诊所更有可能达到 DM23（血糖）目标（估计比值比 1.459；95%CI：1.378-1.544；P=0.0001）。与非 LES 组的全科医生相比，加入 LES 组的全科医生达到满意的 DM23（血糖）水平的概率增加了近 10%。LES 诊所更不可能将患者转介到二级保健机构。
总体而言，LES 诊所在 DM23（血糖）达标方面表现更好，同时也将更少的患者转介到医院，从而实现了他们的目标。这表明 LES 方法是有益的，需要进一步探讨，以确定产生影响的原因是否是 LES。
