School of Population Health, Curtin University, Bentley, Western Australia, Australia
School of Population Health, Curtin University, Bentley, Western Australia, Australia.
BMJ Open. 2021 Nov 10;11(11):e051796. doi: 10.1136/bmjopen-2021-051796.
Continuity and regularity of general practitioner (GP) contacts are associated with reduced hospitalisation in type 2 diabetes (T2DM). We assessed associations of these GP contact patterns with intermediate outcomes reflecting patient monitoring and health.
Observational longitudinal cohort study using general practice data 2011-2017.
193 Australian general practices in Western Australia and New South Wales participating in the MedicineInsight programme run by NPS MedicineWise.
22 791 patients aged 18 and above with T2DM.
Regularity was assessed based on variation in the number of days between GP visits, with more regular contacts assumed to indicate planned, proactive care. Informational continuity (claims for care planning incentives) and relational continuity (usual provider of care index) were assessed separately.
Process of care indicators were glycosylated haemoglobin (HbA1c) test underuse (8 months without test), estimated glomerular filtration rate (eGFR) underuse (14 months) and HbA1c overuse (two tests within 80 days). The clinical indicator was T2DM control (HbA1c 6.5% (47.5 mmol/mol)-7.5% (58.5 mmol/mol)).
The quintile with most regular contact had reduced odds of HbA1c and eGFR underuse (OR 0.74, 95% CI 0.67 to 0.81 and OR 0.78, 95% CI 0.70 to 0.86, respectively), but increased odds of HbA1c overuse (OR 1.20, 95% CI 1.05 to 1.38). Informational continuity was associated with reduced odds of HbA1c underuse (OR 0.53, 95% CI 0.49 to 0.56), reduced eGFR underuse (OR 0.62, 95% CI 0.58 to 0.67) and higher odds of HbA1c overuse (OR 1.48, 95% CI 1.34 to 1.64). Neither had significant associations with HbA1c level. Results for relational continuity differed.
This study provides evidence that regularity and continuity influence processes of care in the management of patients with diabetes, though this did not result in the recording of HbA1c within target range. Research should capture these intermediate outcomes to better understand how GP contact patterns may influence health rather than solely assessing associations with hospitalisation outcomes.
全科医生（GP）接触的连续性和规律性与 2 型糖尿病（T2DM）患者的住院率降低有关。我们评估了这些 GP 接触模式与反映患者监测和健康的中间结果之间的关联。
使用 2011 年至 2017 年的全科医疗数据进行观察性纵向队列研究。
西澳大利亚州和新南威尔士州的 193 家参与 NPS MedicineWise 运营的 MedicineInsight 计划的澳大利亚全科诊所。
22791 名年龄在 18 岁及以上的 T2DM 患者。
根据 GP 就诊之间的天数变化来评估规律性，更多的规律接触被认为是有计划的、主动的护理。分别评估信息连续性（护理计划激励措施的索赔）和关系连续性（常规提供者的护理指数）。
过程护理指标包括糖化血红蛋白（HbA1c）检测不足（8 个月无检测）、估算肾小球滤过率（eGFR）检测不足（14 个月）和 HbA1c 检测过度（80 天内两次检测）。临床指标为 T2DM 控制（HbA1c 6.5%（47.5mmol/mol）-7.5%（58.5mmol/mol））。
接触最规律的五分位数患者 HbA1c 和 eGFR 检测不足的可能性降低（OR 0.74，95%CI 0.67 至 0.81 和 OR 0.78，95%CI 0.70 至 0.86），但 HbA1c 检测过度的可能性增加（OR 1.20，95%CI 1.05 至 1.38）。信息连续性与 HbA1c 检测不足的可能性降低（OR 0.53，95%CI 0.49 至 0.56）、eGFR 检测不足（OR 0.62，95%CI 0.58 至 0.67）和 HbA1c 检测过度的可能性增加（OR 1.48，95%CI 1.34 至 1.64）有关。两者与 HbA1c 水平均无显著关联。关系连续性的结果则有所不同。
本研究提供的证据表明，规律性和连续性影响糖尿病患者的护理过程，尽管这并没有导致 HbA1c 记录在目标范围内。研究应捕捉这些中间结果，以更好地了解 GP 接触模式如何影响健康，而不仅仅是评估与住院结果的关联。
