Low annual frequency of HbA1ctesting in people with Type 2 diabetes in primary care practices in Germany

Purpose Redesigning the system of care for the management of patients with type 2 diabetes mellitus has not been well studied in rural communities with a significant minority population and limited health care resources. This study assesses the feasibility and potential for cost-effectiveness of restructuring care in rural fee-for-service practices for predominantly minority patients with diabetes mellitus. Methods This was a feasibility study of implementing case management, group visits, and electronic registry in 5 solo or small group primary care practices in rural North Carolina. The subjects were 314 patients with type 2 diabetes mellitus (mean age = 61 years; 72% African American; 54% female). An advanced practice nurse visited each practice weekly for 12 months, provided intensive diabetes case management, and facilitated a 4-session group visit educational program. An electronic diabetes registry and visit reminder systems were implemented. Results There was an improvement in the percentage of patients achieving diabetes management goals and an improvement in productivity and billable encounters. The percentage of patients with a documented self-management goal increased from 0% to 42%, a currently documented lipid panel from 55% to 76%, currently documented aspirin use from 25% to 37%, and currently documented foot examination from 12% to 54%. The average daily encounter rate improved from 20.17 to 31.55 on intervention days. Conclusions A redesigned care delivery system that uses case management with structured group visits and an electronic registry can be successfully incorporated into rural primary care practices and appears to significantly improve both care processes and practice productivity.

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Prevalence of depression in type 2 diabetes patients in German primary care practices

Journal of Diabetes and its Complications ◽

10.1016/j.jdiacomp.2015.12.013 ◽

2016 ◽

Vol 30 (3) ◽

pp. 432-437 ◽

Cited By ~ 17

Author(s):

Louis Jacob ◽

Karel Kostev

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Prevalence Of Depression ◽

Care Practices ◽

Primary Care Practices ◽

Diabetes Patients

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Treatment Outcomes and Tolerability Following Initiation of GLP-1 Receptor Agonists Among Type 2 Diabetes Patients in Primary Care Practices in Germany

Journal of Diabetes Science and Technology ◽

10.1177/1932296816661349 ◽

2016 ◽

Vol 11 (2) ◽

pp. 272-277 ◽

Cited By ~ 3

Author(s):

Qing Qiao ◽

Kristina Johnsson ◽

Susan Grandy ◽

Karel Kostev

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Treatment Outcomes ◽

Receptor Agonist ◽

Baseline Hba1c ◽

Care Practices ◽

Primary Care Practices ◽

Diabetes Patients

Background: The aim was to investigate real-world treatment outcomes and tolerability of GLP-1 receptor agonist (GLP-1RA) therapy in patients with type 2 diabetes in Germany. Methods: Patients from 323 primary care practices who started any GLP-1RA therapy (89 Byetta, 108 Bydureon, 347 Victoza patients) between January 1, 2011, and December 31, 2013 (index date) were analyzed retrospectively (Disease Analyzer database, Germany). Changes from baseline in HbA1c, weight, and hypoglycemia were evaluated in 3 follow-up periods of 0-6, 7-12, and 13-18 months. Results: A total of 544 diabetes patients (mean age: 57.9 years; men: 54%) were eligible for the study. Mean (SD) HbA1c (%) decreased from 8.3 (1.4) at baseline to 7.4 (1.2) in 6 months, 7.6 (1.3) in 7-12 months and 7.6 (1.4) in 13-18 months, respectively ( P < .001 for all), while the proportion of patients with HbA1c <7% increased from 15% at baseline to 38%, 36% and 35% in the corresponding periods ( P < .0001 for all). Multivariate-adjusted beta coefficients corresponding to changes in HbA1c (%) from baseline were –.52, –.44, and –.44, respectively, in the follow-up periods for baseline HbA1c (%) ( P < .0001 for all). The prevalence of hypoglycemia at baseline was 0.7%; this did not change significantly after treatment. Conclusions: In clinical practice, GLP-1RA treatment was associated with improved glycemic control without increased hypoglycemia for up to 18 months. The higher the baseline HbA1c, the greater the HbA1c reduction recorded.

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Type 2 diabetes and COPD: treatment in the right healthcare setting? An observational study

BMC Family Practice ◽

10.1186/s12875-021-01424-w ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

R. P. Willink ◽

Rimke C. Vos ◽

I. Looijmans-van den Akker ◽

Huberta E. Hart

Keyword(s):

Type 2 Diabetes ◽

Primary Care ◽

Secondary Care ◽

Healthcare Setting ◽

Health Condition ◽

Correct Treatment ◽

Copd Patients ◽

The Right ◽

Primary Care Practices

Abstract Background Type 2 diabetes (T2DM) and COPD are chronic medical conditions, for which patients need lifelong healthcare. The aim of this study is to examine in which healthcare setting patients with T2DM and COPD receive their care, and if this is the correct healthcare setting according to guidelines. Method T2DM and COPD patients from five primary care practices were included. Data concerning healthcare setting and patient- and clinical characteristics were extracted from the electronic medical records. Patient profiles treated in primary care were compared with the profiles of those treated in secondary care. In patients treated in secondary care we evaluated whether treatment allocation was according to the guidelines and if back-referral to primary care should take place. Results Of the T2DM and COPD patients 7.6% and 29.6% respectively, were treated in secondary care, and 72.7% respectively 31.4% of these were according to the guideline. T2DM patients treated in primary care were older (63 versus 57 years, p < 0.01, had a shorter diabetes duration (8 versus 11 years, p < 0.01) and lower HbA1c (53.0 versus 63.5 mmol/l, p < 0.01) than those treated in secondary care. Those with COPD treated in primary care used less inhalation medication (75.2 versus 90.1%, p < 0.01) and had better spirometry results (67.39 versus 57.53 FEV1%pred, p < 0.01). Conclusion The majority of the patients with T2DM and COPD were correctly treated in primary care and on average patients with a better health condition were treated in primary care.. Also, those who were treated in secondary care were most of the time treated in the correct treatment setting according to the guidelines.

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