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Primary care service utilisation and outcomes in type 2 diabetes: a longitudinal cohort analysis

Primary care service utilisation and outcomes in type 2 diabetes: a longitudinal cohort analysis
Primary care service utilisation and outcomes in type 2 diabetes: a longitudinal cohort analysis
Objectives To describe primary care utilisation patterns among adults with type 2 diabetes and to quantify the association between utilisation and long-term health outcomes. Design Retrospective cohort study. Setting 168 primary care practices in Southern England within the Electronic Care and Health Information Analytics database between 2013 and 2020. Participants 110 240 adults with Quality and Outcomes Framework read code of type 2 diabetes diagnosis; age greater than 18 years; linked and continuous records available from April 2013 until April 2020 (or death). Primary and secondary outcome measures (1) Rates of service utilisation (total number of primary care contacts per quarter) across the study period; (2) participant characteristics associated with higher and lower rates of service utilisation; and (3) associations between service utilisation and (A) cardiovascular disease (CVD events) and (B) all-cause mortality. Results Mean (SD) number of primary care attendances per quarter in the cohort of 110 240 went from 2.49 (2.01) in 2013 to 2.78 (2.06) in 2020. Patients in the highest usage tertile were more likely to be female, older, more frail, white, from the least deprived quintile and to have five or more comorbidities. In adjusted models, higher rates of service utilisation (per consultation) were associated with higher rates of CVD events (OR 1.0058; 95% CI 1.0053 to 1.0062; p<0.001) and mortality (OR 1.0057; 95% CI 1.0051 to 1.0064; p<0.001). Conclusions People with type 2 diabetes are using primary care services more frequently, but increased volume of clinical care does not correlate with better outcomes, although this finding may be driven by more unwell patients contacting services more frequently. Further research on the nature and content of contacts is required to understand how to tailor services to deliver effective care to those at greatest risk of complications.
General diabetes, Organisation of health services, Primary care
2044-6055
Hodgson, Sam
bc059529-009b-4f80-94b7-d5211a175eee
Morgan-Harrisskit, Jeffrey
68942a9c-ccd8-468a-af27-34e7893bc5ae
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Stuart, Beth
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Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1
Hodgson, Sam
bc059529-009b-4f80-94b7-d5211a175eee
Morgan-Harrisskit, Jeffrey
68942a9c-ccd8-468a-af27-34e7893bc5ae
Hounkpatin, Hilda
5612e5b4-6286-48c8-b81f-e96d1148681d
Stuart, Beth
626862fc-892b-4f6d-9cbb-7a8d7172b209
Dambha-Miller, Hajira
58961db5-31aa-460e-9394-08590c4b7ba1

Hodgson, Sam, Morgan-Harrisskit, Jeffrey, Hounkpatin, Hilda, Stuart, Beth and Dambha-Miller, Hajira (2022) Primary care service utilisation and outcomes in type 2 diabetes: a longitudinal cohort analysis. BMJ Open, 12 (1), [e054654]. (doi:10.1136/bmjopen-2021-054654).

Record type: Article

Abstract

Objectives To describe primary care utilisation patterns among adults with type 2 diabetes and to quantify the association between utilisation and long-term health outcomes. Design Retrospective cohort study. Setting 168 primary care practices in Southern England within the Electronic Care and Health Information Analytics database between 2013 and 2020. Participants 110 240 adults with Quality and Outcomes Framework read code of type 2 diabetes diagnosis; age greater than 18 years; linked and continuous records available from April 2013 until April 2020 (or death). Primary and secondary outcome measures (1) Rates of service utilisation (total number of primary care contacts per quarter) across the study period; (2) participant characteristics associated with higher and lower rates of service utilisation; and (3) associations between service utilisation and (A) cardiovascular disease (CVD events) and (B) all-cause mortality. Results Mean (SD) number of primary care attendances per quarter in the cohort of 110 240 went from 2.49 (2.01) in 2013 to 2.78 (2.06) in 2020. Patients in the highest usage tertile were more likely to be female, older, more frail, white, from the least deprived quintile and to have five or more comorbidities. In adjusted models, higher rates of service utilisation (per consultation) were associated with higher rates of CVD events (OR 1.0058; 95% CI 1.0053 to 1.0062; p<0.001) and mortality (OR 1.0057; 95% CI 1.0051 to 1.0064; p<0.001). Conclusions People with type 2 diabetes are using primary care services more frequently, but increased volume of clinical care does not correlate with better outcomes, although this finding may be driven by more unwell patients contacting services more frequently. Further research on the nature and content of contacts is required to understand how to tailor services to deliver effective care to those at greatest risk of complications.

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Accepted/In Press date: 5 January 2022
Published date: 31 January 2022
Additional Information: Funding HD-M is a National Institute for Health Research (NIHR) funded Academic Clinical Lecturer and has received NIHR School of Primary Care Research funding to support this work (SPCR2014-10043). SH is an Academic Clinical Fellow funded by the NIHR.
Keywords: General diabetes, Organisation of health services, Primary care

Identifiers

Local EPrints ID: 454809
URI: http://eprints.soton.ac.uk/id/eprint/454809
ISSN: 2044-6055
PURE UUID: c644759f-b577-4631-bd91-fbd3faaf644e
ORCID for Beth Stuart: ORCID iD orcid.org/0000-0001-5432-7437
ORCID for Hajira Dambha-Miller: ORCID iD orcid.org/0000-0003-0175-443X

Catalogue record

Date deposited: 24 Feb 2022 21:49
Last modified: 28 Apr 2022 02:26

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Contributors

Author: Sam Hodgson
Author: Jeffrey Morgan-Harrisskit
Author: Beth Stuart ORCID iD

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