Differences in treatment regimes, consultation frequency and referral patterns of diabetes mellitus in general practice in five European countries

Abstract

Donker GA, Fleming DM, Schellevis FG and Spreeuwenberg P. Differences in treatment regimes, consultation frequency and referral patterns of diabetes mellitus in general practice in five European countries. Family Practice 2004; 21: 364-369.Background. In many European countries, maturity onset diabetes mellitus (DM) is to a large extent managed in general practice. Objective. Our aim was to compare management of DM in general practice in five European countries in order to contribute to international guidelines on the management of DM by GPs. Methods.Routine monitoring of patients presenting with DM was performed during a 12 month period (1999)(2000) to GPs in established sentinel practice surveillance networks in five European countries (Belgium, Croatia, England, Spain and The Netherlands). Results were stratified by age and country.Results. The proportion of patients treated by diet only varied from 13% (The Netherlands) to 25% (Spain); diet and oral antidiabetics from 51% (England) to 62% (Belgium); a combination of diet and insulin varied from 15% (Belgium and Croatia) to 26% (The Netherlands); and a combination of diet, oral antidiabetics and insulin was Ͻ10% in all countries. In the older age groups, insulin is prescribed most frequently in The Netherlands. Spain and Croatia show high consultation rates for DM; England and The Netherlands show low rates. Referral percentages vary considerably between countries (highest in Croatia).Conclusions. National differences found included the use of insulin in the elderly, the consultation frequency in general practice and the referral rate to ophthalmologist and diabetic specialists. Further quantitative and qualitative studies are needed to explore the needs for support in diabetes management in general practice in Europe.

Quality of Care of People With Type 2 Diabetes in Eight European Countries

“…Findings from the GUIDANCE study also support previous reports of between-country variations in terms of the quality of care of people with type 2 diabetes in Europe (23–26), some of which may be linked to organizational differences. However, results suggest that in the past decade there have been some improvements regarding intermediate outcomes.…”

“…Previous studies have limitations linked to quality and relevance. Some European studies with the advantage of large sample sizes have used aggregated or survey data rather than information collected at individual patient level (22,23), and in one of these studies only two of the seven contributing countries (England and Scotland) were from Europe (22). Findings from a sample of >7,000 cases based on data from the late 1990s (24) are useful but cannot be assumed to reflect recent quality of care and a more recent study using data from 2006 to 2007 was focused mainly on hypoglycemia (25).…”

Resource use and costs of type 2 diabetes patients receiving managed or protocolized primary care: a controlled clinical trial

“…However, we do believe that the results of our study can be extrapolated to other countries and other health care systems with high referral rates to secondary care [33]. …”

Epidemiology of suicide and suicide attempts in Belgium: results from the sentinel network of general practitioners

“…In the past, the network proved to be able to capture morbidity and mortality from other causes such as stroke (Devroey et al 2003) or accidents (Devroey et al 2002). Also, the longstanding collaboration with other European primary care surveillance networks ensures an ongoing process of quality improvement of the instrument (Van Casteren et al 1993a;Van Casteren & Leurquin 1992;Donker et al 2004). Such networks are considered to be potential valuable tools for public health surveillance in Europe (Deckers et al 2006;Fleming et al 2003).…”