Baldo V, Lombardi S, Cocchio S, Rancan S, Buja A, Cozza S, Marangon C, Furlan P, Cristofoletti M
Department of Molecular Medicine, Institute of Hygiene, Laboratory of Public Health and Population Studies, University of Padua, Italy.
Distretto Socio Sanitario, Local Health District n̊5 "Vicentino Ovest", Veneto Region, Italy.
Prim Care Diabetes. 2015 Feb;9(1):54-9. doi: 10.1016/j.pcd.2014.03.005. Epub 2014 Apr 16.
The aim of this observational study was to assess mortality of patients with type 2 diabetes by type of healthcare delivery system, i.e. through specialist centers or generalist doctors, or integrated care.
The study was conducted at the "Vicentino Ovest" Local Health District in the Veneto Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with diabetes (≥ 20 years old) were identified using different public health databases. They were grouped as: patients followed up by specialists at diabetes clinics (DS); patients seen only by their own general practitioner (GP); and patients receiving integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard ratios for available potential predictors of death by level of care.
The crude mortality rate was highest in the GP group (26.1 per 1000 person-years), the difference being minimal when compared with the DS group (21.7 per 1000 person-years) and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the DS-GP group.
The findings of the present study could demonstrate that it is safe and cost-effective, after a first specialist assessment at a diabetes service, for low-risk diabetic patients to be managed by family physicians as part of a coordinated care approach, based on the specialist's clinical recommendations; GPs can subsequently refer patients to a specialist whenever warranted by their clinical condition.
本观察性研究旨在按医疗服务提供系统的类型评估2型糖尿病患者的死亡率，即通过专科中心、全科医生或综合护理。
该研究于2008年1月1日至2010年12月31日在意大利东北部威尼托地区的“维琴蒂诺西部”地方卫生区进行。使用不同的公共卫生数据库识别糖尿病患者（≥20岁）。他们被分为：在糖尿病诊所由专科医生随访的患者（DS）；仅由其自己的全科医生诊治的患者（GP）；以及接受综合护理的患者（DS-GP）。采用Cox回归分析按护理水平估计死亡可用潜在预测因素的调整后风险比。
全科医生组的粗死亡率最高（每1000人年26.1例），与专科医生组（每1000人年21.7例）相比差异最小，与综合护理组（每1000人年8.8例）相比差异更明显。与综合护理组相比，由全科医生随访的患者调整后的死亡相对危险度为2.7。
本研究结果表明，在糖尿病服务机构进行首次专科评估后，低风险糖尿病患者由家庭医生作为协调护理方法的一部分进行管理是安全且具有成本效益的，这基于专科医生的临床建议；全科医生随后可根据患者的临床状况在必要时将其转诊给专科医生。
