Variation between general practitioners in type 2 diabetes processes of care

Abstract

Aims: To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. Methods: Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. Results: We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile . GPs' age >60 years and heavier workload were associated with poorer performance. Conclusion:We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.

Experiences with tailoring of primary diabetes care in well-organised general practices: a mixed-methods study

“…A more flexible protocol should be tailored to specific groups, including individuals needing support in order to obtain appropriate diabetes outcomes [ 45 ]. Considering that adherence to professional treatment protocols is associated with better diabetes knowledge among care providers [ 46 ] and with improved processes of care [ 47 ], we would advocate finding a balance between the benefits of these protocols and protocol-free care. Factors facilitating the application of protocols include a short and simple presentation, recommendations that require minimal resources before implementation and the involvement of end-users in the development, implementation and testing of guidelines [ 17 ].…”

Gestational diabetes mellitus follow-up in Norwegian primary health care: a qualitative study

“…A gap in the quality between recommended and actual care is well-documented, also for patients diagnosed with T2DM (33). In Norwegian general practice, major gaps in complication screening among diabetes patients are shown (34), and a recent study found large variations in GPs performance of care with patient reminders being one factor associated with better performance (35).…”

High adherence to recommended diabetes follow‐up procedures by general practitioners is associated with lower estimated cardiovascular risk

“…We used the same sample as in a previous study exploring the GPs working style (performance of procedures) in the primary prevention of CVD. 11 Those with established CVD and with age ≥75 years were excluded, as well as participants of GPs with <5 participants with type 2 diabetes remaining after inclusion, resulting in a study sample of 6015 participants and 275 GPs. For each GP, the proportions of patients receiving each of the six procedures (measurements of HbA 1c , LDL-cholesterol, albuminuria, blood pressure and recorded foot examination in the past 15 months; and recorded eye examination in the past 30 months) were calculated, and the scores were averaged across all process indicators, resulting in a process performance indicator average ranging from 0% to 100%.…”