Prevalence and characteristics of diabetic patients with no ongoing care in South Auckland.

Simmons, David; Fleming, Carole

doi:10.2337/diacare.23.12.1791

Cited by 21 publications

(32 citation statements)

References 12 publications

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“…The authors concluded that these patients with “milder” disease may have been discharging themselves from clinic due to the belief that their disease was not severe enough to warrant intensive therapy. Simmons et al and Currie et al had similar results [13,24]. The differences between our population of defaulters and defaulters described by others likely reflect the referral pattern of our region in which the more complex patients with advanced disease are referred to tertiary care while patients with milder disease are cared for in the community.…”

Section: Discussionsupporting

confidence: 77%

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic

Malcolm

Maranger

Taljaard

et al. 2013

BMC Health Serv Res

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BackgroundContinuity of care is essential for good quality diabetes management. We recently found that 46% of patients defaulted from care (had no contact with the clinic for 18 months after a follow-up appointment was ordered) in a Canadian multidisciplinary tertiary care diabetes clinic. The primary aim was to compare characteristics, diabetes processes of care, and outcomes from referral to within 1 year after leaving clinic or to the end of the follow-up period among those patients who defaulted, were discharged or were retained in the clinic.MethodsRetrospective cohort study of 193 patients referred to the Foustanellas Endocrine and Diabetes Center (FEDC) for type 2 diabetes from January 1, 2005 to June 30, 2005. The FEDC is the primary academic referral centre for the Ottawa Region and provides multidisciplinary diabetes management. Defaulters (mean age 58.5 ± 12.5 year, 60% M) were compared to patients who were retained in the clinic (mean age 61.4 ± 10.47 years, 49% M) and those who were formally discharged (mean age 61.5 ± 13.2 years, 53.3% M). The chart audit population was then individually linked on an individual patient basis for laboratory testing, physician visits billed through OHIP, hospitalizations and emergency room visits using Ontario health card numbers to health administrative data from the Ministry of Health and Long-Term Care at the Institute for Clinical and Evaluative Sciences (ICES).ResultsRetained and defaulted patients had significantly longer duration of diabetes, more microvascular complications, were more likely to be on insulin and less likely to have a HbA1c < 7.0% than patients discharged from clinic. A significantly lower proportion of patients who defaulted from tertiary care received recommended monitoring for their diabetes (HbA1c measurements, lipid measurements, and periodic eye examinations), despite no difference in median number of visits to a primary care provider (PCP). Emergency room visits were numerically higher in the defaulters group.ConclusionsPatients defaulting from a tertiary care diabetes hospital do not receive the recommended monitoring for their diabetes management despite attending PCP appointments. Efforts should be made to minimize defaulting in this group of individuals.

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Section: Discussionsupporting

confidence: 77%

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic

Malcolm

Maranger

Taljaard

et al. 2013

BMC Health Serv Res

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“…Evidence of age as a predictor of programme attrition or missed diabetes care appointments has been inconsistent in the diabetes literature with some studies reporting an association [17,21,22,28,46], while others not finding an association [10,12,15,25,26]. We found that patients younger than 45 and aged 65 years or older were more likely to drop out from recommended services.…”

Section: Discussionmentioning

confidence: 62%

Patient factors associated with attrition from a self‐management education programme

Gucciardi

DeMelo

Offenheim

et al. 2007

Evaluation Clinical Practice

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Objective To examine utilization patterns of diabetes self-management training (DSME) and identify patient factors associated with attrition from these services at an ambulatory diabetes education centre (DEC). Methods A retrospective medical chart review of first time visits (536) to the centre between I August 2000 and 31 July 2001 was conducted for patients with type 2 diabetes. Descriptive analyses were conducted to examine utilization patterns over a I-year period. Multivariable logistic regression was used to identify patient factors associated with attrition from DSME and non-use of group education among new patients. Results Almost 50% of new patients withdrew prematurely from recommended DSME services over the I-year period, and only 24.8% attended group education. Patient variables such as being older than 65 years of age, primarily speaking English, or working full or part-time were associated with attrition from DSME and non-use of group education when compared with middle aged, non-English-speaking, and non-working patients. Conclusions High DSME attrition rates indicate that retention needs to become a focus of programme policy, planning and evaluation to improve programme effectiveness. DSME tailored to the cultural and linguistic characteristics of the community, and convenient and accessible to working and older patients will potentially increase retention in and accessibility to these services.

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“…The reasons for dropout from a diabetic care can be generally summarized into the following three categories: 1) patient-oriented problem (2,(11)(12)(13)(14)(15)(16)(17), 2) health-care provideroriented problem (11,18,19), and 3) physician-patient relationship (5,20). For the patient-oriented problem, gender, age, ethnicity, educational level, economical status, tobacco use, obesity, the duration of disorder, glycemic control, and psychological problems among others can be considered.…”

Section: Introductionmentioning

confidence: 99%

Personal features and dropout from diabetic care

Masuda

Kubo²,

Kokaze

et al. 2006

Environ. Health Prev. Med.

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Objective: To investigate the personal features associated with dropout from regular outpatient care among persons with type 2 diabetes mellitus (DM).Methods: A total of 160 DM patients were enrolled in the study. As a retrospective analysis, outpatient's clinical characteristics, lifestyle, or social features were gathered from their medical records or interview sheets. All the subjects were divided into two groups by adherence to diabetic care, namely, 'dropout case' (DC) or 'ongoing case' (OC), and were subjected to comparative analysis. We called the patients who did not receive outpatient treatment from the clinic on a regular basis, including treatment from other clinics or dropout of diabetic care, as DC. In contrast, patients who regularly visited the clinic were defined as OC. An unconditional multiple logistic regression analysis was performed to analyze the association of adherence to diabetic care with several personal features.Results: Sixty-eight of 160 subjects (42.5%) were recognized as DC. The remaining 92 subjects (57.5%) were considered as OC. Young age (p=0.045), low plasma glucose (p=0.005) and hemoglobin A1c (HbA1c) levels (p=0.005), nonmedication (p<0.001) and no past history of DM (p=0.007) at the initial visit were the features related to dropout by crude analysis. Even after adjustment for age and gender by multivariate analysis, there remained significant inverse associations of dropout with HbA1c level, medical treatment (oral agents or insulin) and previous DM history. Neither occupation, distance from residence to clinic, smoking habit nor drinking habit was associated with dropout. Dropout mostly occurred after the initial or second visit.Conclusions: A mild condition of DM may be related to dropout from regular outpatient care. It may be necessary to clearly show the objectives and importance of regular visit to an outpatient clinic for diabetic care, particularly for screened mild DM cases in public health activities.

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Prevalence and characteristics of diabetic patients with no ongoing care in South Auckland.

Cited by 21 publications

References 12 publications

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic

Into the abyss: diabetes process of care indicators and outcomes of defaulters from a Canadian tertiary care multidisciplinary diabetes clinic

Patient factors associated with attrition from a self‐management education programme

Personal features and dropout from diabetic care

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