Associations between regular GP contact, diabetes monitoring and glucose control: an observational study using general practice data.
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© Authors. This article has been accepted for publication in BMJ Open following peer review and can also be viewed on the journal’s website at http://dx.doi.org/10.1136/bmjopen-2021-051796.
OBJECTIVE: 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. DESIGN: Observational longitudinal cohort study using general practice data 2011-2017.
SETTING: 193 Australian general practices in Western Australia and New South Wales participating in the MedicineInsight programme run by NPS MedicineWise.
PARTICIPANTS: 22 791 patients aged 18 and above with T2DM.
INTERVENTIONS: 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.
OUTCOME MEASURES: 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)).
RESULTS: 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.
CONCLUSIONS: 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.
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