Profiles of diabetes-related primary care utilisation
According to the guidelines, type II diabetes patients under supervision of GPs should have four regular check-ups within the practice per year [18]. Of our three diabetes-related primary healthcare utilisation profiles, only the patients in profile ‘low utilisation, GP only’ had on average less than the recommended four contacts for diabetes-related issues. Interestingly, this profile represented almost half of the type II diabetes population in general practice. Principal treatment in secondary care (by an internist – in the Netherlands internists are not seen as primary care specialists) could explain the low number of contacts in primary care for part of this subgroup, but we do not have information available in our dataset to confirm this. However, from a report published by the National Institute for Public Health and the Environment (RIVM), it is known that only a small number of type II diabetes patients is under treatment solely by an internist [27], thereby possibly not providing a full explanation for our findings. Thus, part of the type II diabetes patients did not have the recommended four contacts annually for diabetes-related health problems. In general, the patients in the profile with low frequency of contacts are the youngest in the sample, and also show the lowest prevalence of co-morbidity. This might coincide with well-controlled diabetes, indicating a less-frequent need for primary care consultations [28]. In this respect, our findings showing that patients from a quarter of the practices were all assigned to the 'low utilisation, GP only' profile, are notable. It might be that these practices do not provide adequate care to type II diabetes patients, which may be explained by unavailability of primary care nurses.
ของการจัดสรรดูแลหลักที่เกี่ยวข้องกับโรคเบาหวาน According to the guidelines, type II diabetes patients under supervision of GPs should have four regular check-ups within the practice per year [18]. Of our three diabetes-related primary healthcare utilisation profiles, only the patients in profile ‘low utilisation, GP only’ had on average less than the recommended four contacts for diabetes-related issues. Interestingly, this profile represented almost half of the type II diabetes population in general practice. Principal treatment in secondary care (by an internist – in the Netherlands internists are not seen as primary care specialists) could explain the low number of contacts in primary care for part of this subgroup, but we do not have information available in our dataset to confirm this. However, from a report published by the National Institute for Public Health and the Environment (RIVM), it is known that only a small number of type II diabetes patients is under treatment solely by an internist [27], thereby possibly not providing a full explanation for our findings. Thus, part of the type II diabetes patients did not have the recommended four contacts annually for diabetes-related health problems. In general, the patients in the profile with low frequency of contacts are the youngest in the sample, and also show the lowest prevalence of co-morbidity. This might coincide with well-controlled diabetes, indicating a less-frequent need for primary care consultations [28]. In this respect, our findings showing that patients from a quarter of the practices were all assigned to the 'low utilisation, GP only' profile, are notable. It might be that these practices do not provide adequate care to type II diabetes patients, which may be explained by unavailability of primary care nurses.
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