患者及诊所特征在全科诊所2型糖尿病治疗质量差异中的作用
Role of Patient and Practice Characteristics in Variance of Treatment Quality in Type 2 Diabetes between General Practices.
作者信息
Cho Yeon Young, Sidorenkov Grigory, Denig Petra
机构信息
Department of Clinical Pharmacy and Pharmacology, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands.
Department of Epidemiology, Graduate School of Public Health, Seoul National University, Seoul, Republic of Korea.
出版信息
PLoS One. 2016 Nov 2;11(11):e0166012. doi: 10.1371/journal.pone.0166012. eCollection 2016.
BACKGROUND
Accounting for justifiable variance is important for fair comparisons of treatment quality. The variance between general practices in treatment quality of type 2 diabetes (T2DM) patients may be attributed to the underlying patient population and practice characteristics. The objective of this study is to describe the between practice differences in treatment, and identify patient and practice level characteristics that may explain these differences.
METHODS
The data of 24,607 T2DM patients from 183 general practices in the Netherlands were used. Treatment variance was assessed in a cross-sectional manner for: glucose-lowering drugs/metformin, lipid-lowering drugs/statins, blood pressure-lowering drugs/ACE-inhibitor or ARB. Patient characteristics tested were age, gender, diabetes duration, comorbidity, comedication. Practice characteristics were number of T2DM patients, practice type, diabetes assistant available. Multilevel logistic regression was used to examine the between practice variance in treatment and the effect of characteristics on this variance.
RESULTS
Treatment rates varied considerably between practices (IQR 9.5-13.9). The variance at practice level was 7.5% for glucose-lowering drugs, 3.6% for metformin, 3.1% for lipid-lowering drugs, 10.3% for statins, 8.6% for blood pressure-lowering drugs, and 3.9% for ACE-inhibitor/ARB. Patient and practice characteristics explained 19.0%, 7.5%, 20%, 6%, 9.9%, and 13.4% of the variance respectively. Age, multiple chronic drugs, and ≥3 glucose-lowering drugs were the most relevant patient characteristics. Number of T2DM patients per practice was the most relevant practice characteristic.
DISCUSSION
Considerable differences exist between practices in treatment rates. Patients' age was identified as characteristic that may account for justifiable differences in especially lipid-lowering treatment. Other patient or practice characteristics either do not explain or do not justify the differences.
背景
考虑合理的差异对于公平比较治疗质量很重要。2型糖尿病（T2DM）患者治疗质量在全科医疗实践之间的差异可能归因于潜在的患者群体和医疗实践特征。本研究的目的是描述治疗方面的医疗实践差异，并确定可能解释这些差异的患者和医疗实践层面的特征。
方法
使用了来自荷兰183家全科医疗实践的24607例T2DM患者的数据。以横断面方式评估治疗差异，涉及：降糖药物/二甲双胍、降脂药物/他汀类药物、降压药物/血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂。测试的患者特征包括年龄、性别、糖尿病病程、合并症、合并用药。医疗实践特征包括T2DM患者数量、医疗实践类型、是否有糖尿病助手。使用多水平逻辑回归来检验治疗方面的医疗实践差异以及特征对该差异的影响。
结果
不同医疗实践之间的治疗率差异很大（四分位距9.5 - 13.9）。医疗实践层面降糖药物的差异为7.5%，二甲双胍为3.6%，降脂药物为3.1%，他汀类药物为10.3%，降压药物为8.6%，血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂为3.9%。患者和医疗实践特征分别解释了差异的19.0%、7.5%、20%、6%、9.9%和13.4%。年龄、多种慢性药物以及≥3种降糖药物是最相关的患者特征。每个医疗实践中的T2DM患者数量是最相关的医疗实践特征。
讨论
不同医疗实践之间的治疗率存在显著差异。患者年龄被确定为可能解释特别是降脂治疗中合理差异的特征。其他患者或医疗实践特征要么无法解释差异，要么不能说明差异的合理性。
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