A comparative study of two various models of organising diabetes follow-up in public primary health care - the model influences the use of services, their quality and costs

被引:15
作者
Honkasalo, Mikko T. [1 ]
Linna, Miika [2 ]
Sane, Timo [3 ]
Honkasalo, Atte [4 ]
Elonheimo, Outi [5 ]
机构
[1] Univ Helsinki, Univ Cent Hosp Helsinki, Unit Gen Practice, Nurmijarvi Hlth Ctr,Network Acad Hlth Ctr, Helsinki, Finland
[2] Aalto Univ, Helsinki, Finland
[3] Univ Cent Hosp Helsinki, Dept Endocrinol, Helsinki, Finland
[4] Qvantel Oy, Espoo, Finland
[5] Univ Helsinki, Univ Cent Hosp Helsinki, Unit Gen Practice, Network Acad Hlth Ctr, Helsinki, Finland
关键词
Type; 1; diabetes; Organisation of diabetes care; Costs of diabetes care; Patient satisfaction; Comparison of diabetes care; PHC diabetes care; GLYCEMIC CONTROL;
D O I
10.1186/1472-6963-14-26
中图分类号
R19 [保健组织与事业(卫生事业管理)];
学科分类号
摘要
Background: In Finland diabetologists have long been concerned about the level of diabetes care as the incidence of type 1 diabetes and complicated type 2 diabetes is exceeding the capacity of specialist clinics. We compared the outcome of diabetes care in two middle-sized Finnish municipalities with different models of diabetes care organisation in public primary health care. In Kouvola the primary health care of all diabetic patients is based on general practitioners, whereas in Nurmijarvi the follow-up of type 1 and most complicated type 2 diabetic patients is assigned to a general practitioner specialised in diabetes care. Methods: Our study population consisted of all adult diabetic patients living in the municipalities under review. We compared the use and costs of public diabetes care, glycemic control, blood pressure, LDL-cholesterol level, the application of the national guidelines and patient satisfaction. The main outcome measures were the costs and use of health care services due to diabetes and its complications. Results: In Nurmijarvi, where diabetes care was centralised, more type 1 diabetic patients were followed up in primary health care than in Kouvola, where general practitioners need more specialist consultations. The centralisation resulted in cost savings in the diabetes care of type 1 diabetic patients. Although the quality of care was similar, type 1 diabetic patients were more satisfied with their follow-up in the centralised system. In the care of type 2 diabetic patients the centralised system required fewer specialist consultations, but the quality and costs were similar in both models. Conclusions: The follow-up of most diabetic patients - including type 1 diabetes - can be organised in primary health care with the same quality as in secondary care units. The centralised primary care of type 1 diabetes is less costly and requires fewer specialist consultations.
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页数:8
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