Quality of care in diabetic patients attending routine primary care clinics compared with those attending GP specialist clinics

Introduction: Defaulted appointment in diabetic clinics is a great concern as it affects disease controlled and complications. Geographical location, clinic-types and quality of health services provided are known determinant reasons for defaulting. Thus, this study aimed to identify characteristics and reasons for default between diabetic-patients at public-primary-care-clinics (PPCCs) and public-hospital-diabetic-specialist-clinic (DS-OPD). Methods: A prospective one-year-cohort study was conducted among 405 diabetic patients from two PPCCs and DS-OPD in Kuantan (2015-2016). There were 2-point visits (at 6-month and 12-month) assessing follow-up appointments within one year. Defaulter is defined by at least one-time defaulted either at 6-month or 12-month. Regular-attendees were included as control. Type-1-DM-patients, missing-records, known-deceased and transferout cases were excluded. Background socio-demographic data of diabetic-defaulters were collected from DM-records and reasons for defaulting were traced via 3-times-telephone contacts which 51.6% diabetic-defaulters responded. A stratified cross-analysis was done to compare the prevalence and characteristics between defaulters and regular attendees. Reasons for defaults were analyzed using open-ended-questions analysis method. Results: Prevalence of defaulters was 18% (73/405); higher prevalence was found in DS-OPD than PPCCs (32.4% vs 10.3%). Gender, race, age, education, occupation and the duration of DM were not significantly different between defaulters and regular-attendees at DS-OPD. However, self-employment (25.9%), housewives (25.9%), aged less than 45-years (33.3%) and≥ 55 years-old (44.4%) were significant defaulters in PPCCs. Significant different of reasons for default found at DS-OPD compare to PPCCs for postponing the date (54.5% vs 12.5%), while refusing treatment/used alternative medicine (18.2% vs 43.8%); and movedout/transferred/referred cases (27.3% vs 31.2%) were more in PPCCs. Conclusions: Distinctive characteristics and diverse reasons for default between DS-OPD and PPCCs among diabetic-patients fortified to set tailored remedial to reduce defaulter-rate in different clinic.

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The Effects Of Practice Size On Quality Of Care In Primary Care Settings: A Systematic Review

The JBI Database of Systematic Reviews and Implementation Reports ◽

10.11124/01938924-201210270-00001 ◽

2012 ◽

Vol 10 (27) ◽

pp. 1549-1633

Author(s):

Ng Kok Ping ◽

Ng Charis Wei Ling

Keyword(s):

Systematic Review ◽

Primary Care ◽

Quality Of Care ◽

Primary Care Settings ◽

Practice Size

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Impact of electronic diabetes registry ‘Meaningful Use’ on quality of care and hospital utilization

Journal of the American Medical Informatics Association ◽

10.1093/jamia/ocv040 ◽

2015 ◽

Vol 23 (2) ◽

pp. 242-247 ◽

Cited By ~ 15

Author(s):

Wencui Han ◽

Raj Sharman ◽

Arvela Heider ◽

Nancy Maloney ◽

Min Yang ◽

...

Keyword(s):

Type 2 Diabetes ◽

Quality Of Care ◽

Hierarchical Linear Modeling ◽

Meaningful Use ◽

Hospital Utilization ◽

Utilization Rate ◽

Diabetic Patients ◽

Diabetes Registry

Abstract Objective To investigate whether the use of diabetes registries meeting Meaningful Use core objectives in primary care practices is associated with differences in quality of care and hospital utilization rates. Materials and methods A practice assessment survey was conducted to identify whether and how practices were using diabetes registries. Insurance claims data from 2010 were used to compare the health outcomes of patients from practices that used diabetes registries meeting Meaningful Use–related objectives to the outcomes of patients from other practices. Logistic hierarchical linear modeling was used to analyze the data. Results Records from 12,514 diabetic patients (including 10 809 with type 2 diabetes) from 50 urban practices were included in the analysis. The results suggest that patients with type 2 diabetes who were treated in practices using registries for patient reminders were more likely to have completed the recommended laboratory testing (odds ratio [OR] 1.26, p < 0.01) and dilated retinal examinations (OR 1.14, p < 0.01). Patients in practices using registries for quality improvement were less likely to have ‘avoidable hospitalization’ (OR 0.83, p < 0.01) and emergency room visits (OR 0.76, p < 0.01). The use of a diabetes registry did not have a significant impact on the quality of care or hospital utilization for patients with type 1 diabetes. Conclusion Use of diabetes registries meeting Meaningful Use core objectives is associated with higher completion or recommended lab tests and a lower hospital utilization rate for patients with type 2 diabetes.

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