Association between GP participation in a primary care group and monitoring of biomedical and lifestyle target indicators in people with type 2 diabetes: a cohort study (ELZHA cohort-1)

Abstract

ObjectiveWhether care group participation by general practitioners improves delivery of diabetes care is unknown. Using ‘monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines’ as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2).DesignObservational, real-life cohort study.SettingPrimary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group.ParticipantsAim 1:From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included.Aim 2:From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included.ExposureCare group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. ‘Monitoring as recommended’ represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise).Primary outcome measuresAim 1:In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013).Aim 2:Odds of monitoring as recommended in new and experienced practices in 2014 were compared.ResultsAim 1:After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001).Aim 2:Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844).ConclusionsWe observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices—indicating that providing diabetes care within a collective approach rapidly improves registration of care.

Socioeconomic status is not associated with the delivery of care in people with diabetes but does modify HbA1c levels: An observational cohort study (Elzha‐cohort 1)

“…The aims of this approach include improving oversight of the diabetes population and up-to-date monitoring outcomes as well as tailored support for practices to achieve optimal delivery of care. 20 Comparable approaches resulted in the impressive amelioration of care delivery, regardless of socioeconomic deprivation. 28,29 Interestingly, the crude findings-suggesting significantly lower monitoring in deprived neighbourhoods and better monitoring in advantageous neighbourhoods-are in line with previous findings in other settings.…”

“…We recently found that care group participation by GPs is associated with an improvement of the monitoring of biomedical and lifestyle-related target indicators in people with type 2 diabetes. 20 Monitoring is considered an important measure for quality of care, since it is associated with better HbA1c levels. 21 Studies on health inequalities in primary and secondary diabetes care have shown that a lower socioeconomic status is associated with worse monitoring and outcomes in people with diabetes, including early death.…”

“…The ELZHA care group setting and the context of the Dutch healthcare system have been described in detail elsewhere. 20,21 For the present study, the socioeconomic status of all urban GP practice locations was determined using a combined deprivation score on the level of neighbourhoods, 24 computed by the local municipality of The Hague. 24 The following parameters are included in this score: (a) percentage inhabitants unemployed for more than 3 years, (b) average income, (c) percentage non-western migrants, (d) average official value of houses, and (e) percentage inhabitants that moved in the last 3 years.…”

“…We recently found that care group participation by GPs is associated with an improvement of the monitoring of biomedical and lifestyle‐related target indicators in people with type 2 diabetes 20 . Monitoring is considered an important measure for quality of care, since it is associated with better HbA1c levels 21 .…”

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

“…Structured type 2 diabetes primary care is associated with improved monitoring of key biomedical and lifestyle-related health indicators [ 10 , 11 ] and better monitoring of these indicators is associated with lower HbA1c levels [ 12 ], particularly in poorly-controlled people [ 13 ]. However, given that guideline compliance is known to be affected by physician attitudes [ 14 ], protocol-based delivery of diabetes primary care is the subject of growing discussion.…”