Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway.
Prim Care Diabetes. 2021 Jun;15(3):495-501. doi: 10.1016/j.pcd.2020.11.018. Epub 2021 Jan 19.
To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease.
Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance.
We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37-4.92). GPs' age >60 years and heavier workload were associated with poorer performance.
We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.
探讨 75 岁以下无心血管疾病的 2 型糖尿病患者中，全科医生（GP）在 6 项推荐治疗方案上的表现差异。
本研究基于 2014 年的电子健康记录，对挪威的糖尿病护理质量进行了横断面研究。根据 6 项护理流程的综合表现，将 GP（按诊所聚类）分为五分位数。我们拟合了一个多水平部分有序回归模型，以确定与表现更好的五分位数相关的 GP 因素。
我们从 77 个诊所的 275 名 GP 中确定了 6015 名 2 型糖尿病患者。GP 的平均执行率为 63.4%；最差五分位数的平均执行率为 46%，最佳五分位数的平均执行率为 81%，个体 GP 的差异较大。调整后，使用结构化随访表与 GP 处于上三个五分位数相关（OR 12.4（95%CI 2.37-65.1））。提醒常规与处于更好的五分位数相关（OR 2.6（1.37-4.92））。GP 年龄>60 岁和工作量较大与较差的表现相关。
我们发现 GP 在护理流程表现上存在较大差异。反映结构和工作量的因素与表现密切相关。
