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

Abstract

BackgroundContinuity 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.MethodsRetrospective 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).ResultsRetained 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.ConclusionsPatients 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.

Factors affecting follow-up non-attendance in patients with Type 2 diabetes mellitus and hypertension: a systematic review

“…A total of 32 patient factors from 19 studies (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) were identified (Table II). The studies investigated the different patient factors that may affect an individual's willingness and ability to return for followup at their respective health clinics.…”

“…(18,30) For alcohol, smoking and substance use, several studies showed no association with FUNA. (19,27,29,30,33) However, three studies found that FUNA was positively associated with smoking. (18,19,23) As for knowledge, beliefs and attitudes, patients with FUNA were positively associated with poor knowledge of their disease, belief that their medications do not work and lack of satisfaction with their DM care.…”

“…Disease and medication factors 35 disease and medication factors from 15 studies (16,(18)(19)(20)(22)(23)(24)(25)(27)(28)(29)(30)(31)(32)(33) were elucidated (Table III). While several studies revealed that poor disease control, especially baseline glycated haemoglobin (HbA1c) level, was positively associated with FUNA, a number of other studies showed that higher systolic and diastolic blood pressure, poor lipid profile, and baseline HbA1c had no association with FUNA.…”

“…While several studies revealed that poor disease control, especially baseline glycated haemoglobin (HbA1c) level, was positively associated with FUNA, a number of other studies showed that higher systolic and diastolic blood pressure, poor lipid profile, and baseline HbA1c had no association with FUNA. (16,18,20,24,25,(27)(28)(29)(30)(31) Several studies showed that high body mass index and a longer duration of DM did not have any association with FUNA. (16,18,23,24,32) As for the presence of complications of disease in patients, some studies showed that diabetic retinopathy and nephropathy had no association with FUNA, while several others showed a positive or varied association.…”

Quality of Diabetes Care at Outpatient Clinic, Sultan Qaboos University Hospital

“…10,12 The clinical outcomes from care that patients with T2D received at SQUH did not match those from Europe, 17,18 North America, 19 Canada, 20 and Australia. 21 Compared to reports from similar tertiary centers in Europe, 17 Canada, 20 and Australia, 21 clinical outcomes in Omani patients were lower. For example, 42% of the patients in Portugal, USA, and Canada were at HbA 1C goal (<7.0%) 17,19 compared to 22% in Oman.…”