Centre for Remote Health, Flinders University and Charles Darwin University, Alice Springs, NT, Australia.
Health Gains Planning Branch, Department of Health, Darwin, NT, Australia.
Med J Aust. 2014 Jun 16;200(11):658-62. doi: 10.5694/mja13.11316.
To evaluate the costs and health outcomes associated with primary care use by Indigenous people with diabetes in remote communities in the Northern Territory.
DESIGN, SETTING AND PARTICIPANTS: A population-based retrospective cohort study from 1 January 2002 to 31 December 2011 among Indigenous NT residents ≥ 15 years of age with diabetes who attended one of five hospitals or 54 remote clinics in the NT.
Hospitalisations, potentially avoidable hospitalisations (PAH), mortality and years of life lost (YLL). Variables included disease stage (new, established or complicated cases) and primary care use (low, medium or high).
14 184 patients were eligible for inclusion in the study. Compared with the low primary care use group, the medium-use group (patients who used primary care 2-11 times annually) had lower rates of hospitalisation, lower PAH, lower death rates and fewer YLL. Among complicated cases, this group showed a significantly lower mean annual hospitalisation rate (1.2 v 6.7 per person [P < 0.001]) and PAH rate (0.72 v 3.64 per person [P < 0.001]). Death rate and YLL were also significantly lower (1.25 v 3.77 per 100 population [P < 0.001] and 0.29 v 1.14 per person-year [P < 0.001], respectively). The cost of preventing one hospitalisation for diabetes was $248 for those in the medium-use group and $739 for those in the high-use group. This compares to $2915, the average cost of one hospitalisation.
Improving access to primary care in remote communities for the management of diabetes results in net health benefits to patients and cost savings to government.
评估北领地偏远社区中糖尿病原住民患者的初级保健利用与成本效益和健康结果之间的关系。
设计、地点和参与者：这是一项基于人群的回顾性队列研究，研究对象为 2002 年 1 月 1 日至 2011 年 12 月 31 日期间在北领地居住且年龄≥15 岁的糖尿病原住民患者，他们曾在北领地的五家医院或 54 家偏远诊所就诊过。
住院治疗、可避免住院治疗（PAH）、死亡率和生命损失年（YLL）。变量包括疾病阶段（新发病例、已确诊病例或复杂病例）和初级保健利用情况（低、中或高）。
14 184 名患者符合纳入研究的标准。与低初级保健利用组相比，中保健利用组（每年利用初级保健 2-11 次的患者）的住院治疗率、PAH 发生率、死亡率和 YLL 均较低。在复杂病例中，该组的年平均住院治疗率（1.2 次/人比 6.7 次/人[P<0.001]）和 PAH 发生率（0.72 次/人比 3.64 次/人[P<0.001]）明显较低。死亡率和 YLL 也明显较低（1.25 人/100 人比 3.77 人/100 人[P<0.001]和 0.29 人/人年比 1.14 人/人年[P<0.001]）。预防一次糖尿病住院治疗的成本为中保健利用组 248 美元，高保健利用组 739 美元。相比之下，一次住院治疗的平均费用为 2915 美元。
改善偏远社区的糖尿病初级保健管理服务，为患者带来了健康效益，为政府节省了成本。
