Karimova Kateryna, Friedmacher Catriona Mairi, Lemke Dorothea, Glushan Anastasiya
Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany
Institute of General Practice, Goethe University Frankfurt, Frankfurt, Germany.
BJGP Open. 2024 Oct 29;8(3). doi: 10.3399/BJGPO.2024.0061. Print 2024 Oct.
Diabetes mellitus is a growing, costly, and potentially preventable public health issue. In 2004, Germany introduced the GP-centred healthcare programme to strengthen primary care.
To assess the hazards of the most common diabetes-related complications in patients enrolled in GP-centred health care in comparison with usual primary care.
DESIGN & SETTING: A retrospective cohort study based on German claims data (4 million members) from 2011-2020.
In total, 217 964 patients with diabetes were monitored from 2011-2020. Endpoints were blindness, amputation, myocardial infarction, stroke, coronary heart disease, dialysis, hypoglycaemia, and all-cause mortality. Cox proportional-hazards regression models were used for multivariable analysis and adjusted for sociodemographic, practice, and disease-specific characteristics.
Compared with usual care ( = 98 609 patients), GP-centred health care ( = 119 355 patients) showed a relative risk reduction of blindness of 12%, and amputation of 20% over 10 years. The estimated impact of GP-centred health care on myocardial infarction, stroke, coronary artery disease, dialysis, and all-cause mortality is significantly favourable in comparison with usual care. However, the proportional risk of hypoglycaemia (+1.2%) in the interventional group is higher than in usual care.
Enrolment in GP-centred health care appears to result in a consistent reduction of the relative risk of diabetes-related complications over 10 years. The significant difference in contrast to usual care may be explained by robust, structured primary care provision, including the diabetes disease management programme, and improved coordination and networking of care within primary and secondary care.
糖尿病是一个日益严重、成本高昂且具有潜在可预防性的公共卫生问题。2004年，德国推出了以全科医生为中心的医疗保健计划，以加强初级保健。
评估与常规初级保健相比，参与以全科医生为中心的医疗保健的患者中最常见的糖尿病相关并发症的风险。
一项基于2011 - 2020年德国索赔数据（400万成员）的回顾性队列研究。
2011年至2020年期间，共监测了217964例糖尿病患者。终点指标为失明、截肢、心肌梗死、中风、冠心病、透析、低血糖和全因死亡率。采用Cox比例风险回归模型进行多变量分析，并对社会人口统计学、医疗实践和疾病特异性特征进行了调整。
与常规护理组（98609例患者）相比，以全科医生为中心的医疗保健组（119355例患者）在10年内失明的相对风险降低了12%，截肢的相对风险降低了20%。与常规护理相比，以全科医生为中心的医疗保健对心肌梗死、中风、冠状动脉疾病、透析和全因死亡率的估计影响明显更有利。然而，干预组低血糖的比例风险（+1.2%）高于常规护理组。
参与以全科医生为中心的医疗保健似乎能在10年内持续降低糖尿病相关并发症的相对风险。与常规护理的显著差异可能是由于提供了强有力的、结构化的初级保健，包括糖尿病疾病管理计划，以及改善了初级和二级护理之间的护理协调和网络。
