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

Malcolm JC, Maranger J, Taljaard M, Shah B, Tailor C, Liddy C, Keely E, Ooi T - BMC Health Serv Res (2013)

Bottom Line: 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).Emergency room visits were numerically higher in the defaulters group.Efforts should be made to minimize defaulting in this group of individuals.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Continuity 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.

Methods: Retrospective 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).

Results: Retained 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.

Conclusions: Patients 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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Related in: MedlinePlus

Percentage of patients in each group achieving 2003 Canadian Diabetes Association recommended targets for HbA1c, LDL-C and BP.
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Figure 1: Percentage of patients in each group achieving 2003 Canadian Diabetes Association recommended targets for HbA1c, LDL-C and BP.

Mentions: The percentages of patients meeting 2003 CDA Guideline recommended targets for HbA1c, LDL-C and BP at their last clinic visit are presented in Figure 1. The defaulted group had the lowest proportion of patients meeting all three targets at 4.8%. Of the patients who attained treatment targets for LDL-C and HbA1c, retained patients were more likely to be on insulin at their last clinic appointment (44.4%) than those discharged (12.0%) or defaulted (7.7%) but these differences were not statistically significant at the Bonferroni-corrected levels. There were no statistically significant differences in microvascular or macrovascular complications among groups in patients who had reached 2 or 3 targets at their last clinic visit.


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

Malcolm JC, Maranger J, Taljaard M, Shah B, Tailor C, Liddy C, Keely E, Ooi T - BMC Health Serv Res (2013)

Percentage of patients in each group achieving 2003 Canadian Diabetes Association recommended targets for HbA1c, LDL-C and BP.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3750860&req=5

Figure 1: Percentage of patients in each group achieving 2003 Canadian Diabetes Association recommended targets for HbA1c, LDL-C and BP.
Mentions: The percentages of patients meeting 2003 CDA Guideline recommended targets for HbA1c, LDL-C and BP at their last clinic visit are presented in Figure 1. The defaulted group had the lowest proportion of patients meeting all three targets at 4.8%. Of the patients who attained treatment targets for LDL-C and HbA1c, retained patients were more likely to be on insulin at their last clinic appointment (44.4%) than those discharged (12.0%) or defaulted (7.7%) but these differences were not statistically significant at the Bonferroni-corrected levels. There were no statistically significant differences in microvascular or macrovascular complications among groups in patients who had reached 2 or 3 targets at their last clinic visit.

Bottom Line: 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).Emergency room visits were numerically higher in the defaulters group.Efforts should be made to minimize defaulting in this group of individuals.

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Background: Continuity 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.

Methods: Retrospective 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).

Results: Retained 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.

Conclusions: Patients 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.

Show MeSH
Related in: MedlinePlus