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Associations between regular GP contact, diabetes monitoring and glucose control: An observational study using general practice data

Version 3 2024-06-14, 07:15
Version 2 2024-06-06, 02:05
Version 1 2023-02-22, 04:52
journal contribution
posted on 2024-06-14, 07:15 authored by D Youens, Suzanne RobinsonSuzanne Robinson, J Doust, MN Harris, R Moorin
ObjectiveContinuity 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.DesignObservational longitudinal cohort study using general practice data 2011–2017.Setting193 Australian general practices in Western Australia and New South Wales participating in the MedicineInsight programme run by NPS MedicineWise.Participants22 791 patients aged 18 and above with T2DM.InterventionsRegularity 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.Outcome measuresProcess 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)).ResultsThe 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.ConclusionsThis 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.

History

Journal

BMJ Open

Volume

11

Article number

ARTN e051796

Location

England

ISSN

2044-6055

eISSN

2044-6055

Language

English

Publication classification

C1.1 Refereed article in a scholarly journal

Issue

11

Publisher

BMJ PUBLISHING GROUP