Need and disparities in primary care management of patients with diabetes

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• 作者：Alessandra Buja (1)
  Rosa Gini (2)
  Modesta Visca (3)
  Gianfranco Damiani (4)
  Bruno Federico (5)
  Daniele Donato (6)
  Paolo Francesconi (2)
  Alessandro Marini (7)
  Andrea Donatini (8)
  Salvatore Brugaletta (9)
  Giorgia Bardelle (1)
  Vincenzo Baldo (1)
  Mariadonata Bellentani (3)
  Valore Project
  
  1. Department of Molecular Medicine of the University of Padova ; Laboratory of Public Health and Population Studies ; Via Loredan ; 18 ; 35100 ; Padova ; Italy
  2. Toscana Region Healthcare Agency ; Florence ; 50100 ; Italy
  3. Healthcare Organization Department ; National Health Agency ; Rome ; 00100 ; Italy
  4. Catholic University of Sacred Heart ; Rome ; 00100 ; Italy
  5. University of Cassino and Southern Lazio ; Cassino ; 03043 ; Italy
  6. Local Health Unit 16 Padua ; Veneto Region ; Padua ; 35100 ; Italy
  7. Zona Territoriale Senigallia ; Regione Marche ; Senigallia ; 60019 ; Italy
  8. Regione Emilia Romagna ; Bologna ; 40100 ; Italy
  9. ASP 7 Ragusa ; Regione Sicilia ; Ragusa ; 97100 ; Italy
  
• 关键词：Health care research ; Quality of care ; Prevalence ; Inequalities
• 刊名：BMC Endocrine Disorders
• 出版年：2014
• 出版时间：December 2014
• 年：2014
• 卷：14
• 期：1
• 全文大小：301 KB
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  37. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1472-6823/14/56/prepub
  
• 刊物主题：Endocrinology; Metabolic Diseases; Internal Medicine;
• 出版者：BioMed Central
• ISSN：1472-6823

文摘

Background An aging population means that chronic illnesses, such as diabetes, are becoming more prevalent and demands for care are rising. Members of primary care teams should organize and coordinate patient care with a view to improving quality of care and impartial adherence to evidence-based practices for all patients. The aims of the present study were: to ascertain the prevalence of diabetes in an Italian population, stratified by age, gender and citizenship; and to identify the rate of compliance with recommended guidelines for monitoring diabetes, to see whether disparities exist in the quality of diabetes patient management. Methods A population-based analysis was performed on a dataset obtained by processing public health administration databases. The presence of diabetes and compliance with standards of care were estimated using appropriate algorithms. A multilevel logistic regression analysis was applied to assess factors affecting compliance with standards of care. Results 1,948,622 Italians aged 16+ were included in the study. In this population, 105,987 subjects were identified as having diabetes on January 1st, 2009. The prevalence of diabetes was 5.43% (95% CI 5.33-5.54) overall, 5.87% (95% CI 5.82-5.92) among males, and 5.05% (95% CI 5.00-5.09) among females. HbA1c levels had been tested in 60.50% of our diabetic subjects, LDL cholesterol levels in 57.50%, and creatinine levels in 63.27%, but only 44.19% of the diabetic individuals had undergone a comprehensive assessment during one year of care. Statistical differences in diabetes care management emerged relating to gender, age, diagnostic latency period, comorbidity and citizenship. Conclusions Process management indicators need to be used not only for the overall assessment of health care processes, but also to monitor disparities in the provision of health care.