Trimberg Research Academy, University of Bamberg, 96045, Bamberg, Germany.
Department of Psychology and Psychotherapy, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58448, Witten, Germany.
BMC Health Serv Res. 2020 Aug 26;20(1):800. doi: 10.1186/s12913-020-05421-0.
Visits to the primary diabetes care provider play a central role in diabetes care. Therefore, patients should attend their primary diabetes care providers whenever a visit is necessary. Parameters that might affect whether this condition is fulfilled include accessibility (in terms of travel distance and travel time to the practice), as well as aspects of service quality (for example in-practice waiting time and quality of the provider's communication with the patient). The relationships of these variables with the frequency of visits to the primary diabetes care provider are investigated.
The investigation is performed with questionnaire data of 1086 type 2 diabetes patients from study regions in England (213), Finland (135), Germany (218), Greece (153), the Netherlands (296) and Spain (71). Data were collected between October 2011 and March 2012. Data were analysed using log-linear Poisson regression models with self-reported numbers of visits in a year to the primary diabetes care provider as the criterion variable. Predictor variables of the core model were: country; gender; age; education; stage of diabetes; heart problems; previous stroke; problems with lower extremities; problems with sight; kidney problems; travel distance and travel time; in-practice waiting time; and quality of communication. To test region-specific characteristics, the interaction between the latter four predictor variables and study region was also investigated.
When study regions are merged, travel distance and in-practice waiting time have a negative effect, travel time no effect and quality of communication a positive effect on visit frequency (with the latter effect being by far largest). When region specific effects are considered, there are strong interaction effects shown for travel distance, in-practice waiting time and quality of communication. For travel distance, as well as for in-practice waiting time, there are region-specific effects in opposite directions. For quality of communication, there are only differences in the strength with which visit frequency increases with this variable.
The impact of quality of communication on visit frequency is the largest and is stable across all study regions. Hence, increasing quality of communication seems to be the best approach for increasing visit frequency.
初级糖尿病护理提供者的就诊对于糖尿病护理起着核心作用。因此，只要有就诊需求，患者就应前往初级糖尿病护理提供者处就诊。可能影响是否满足这一条件的参数包括可及性（出行距离和前往诊所的时间）以及服务质量方面（例如诊所内的等待时间以及提供者与患者沟通的质量）。本研究调查了这些变量与初级糖尿病护理提供者就诊频率之间的关系。
本研究使用了来自英国（213 例）、芬兰（135 例）、德国（218 例）、希腊（153 例）、荷兰（296 例）和西班牙（71 例）研究区域的 1086 例 2 型糖尿病患者的问卷调查数据。数据收集于 2011 年 10 月至 2012 年 3 月期间。使用对数线性泊松回归模型分析以自我报告的一年中初级糖尿病护理提供者就诊次数作为因变量。核心模型的预测变量包括：国家；性别；年龄；教育程度；糖尿病阶段；心脏问题；既往中风；下肢问题；视力问题；肾脏问题；出行距离；出行时间；诊所内等待时间；以及沟通质量。为了检验区域特异性特征，还研究了后四个预测变量与研究区域之间的交互作用。
当合并研究区域时，出行距离和诊所内等待时间与就诊频率呈负相关，出行时间无影响，沟通质量与就诊频率呈正相关（后者的影响最大）。当考虑区域特异性影响时，出行距离、诊所内等待时间和沟通质量显示出强烈的交互作用。对于出行距离和诊所内等待时间，存在方向相反的区域特异性效应。对于沟通质量，仅存在就诊频率随该变量增加的强度差异。
沟通质量对就诊频率的影响最大，且在所有研究区域均保持稳定。因此，提高沟通质量似乎是增加就诊频率的最佳方法。
