Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes

Caughey, G.E., Vitry, A.I., Ramsay, E.N., Gilbert, A.L., Shakib, S., Ryan, P., Esterman, A., McDermott, R.A., and Roughead, E.E. (2016) Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes. Internal Medicine Journal, 46 (12). pp. 1430-1436.

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Abstract

Background: Little is known about the impact of a general practitioner management plan (GPMP) on health outcomes of patients with diabetes.

Aim: To examine the impact of a GPMP on the risk of hospitalisation for diabetes.

Methods: A retrospective study using administrative data from the Australian Government Department of Veterans' Affairs was conducted (1 July 2006 to 30 June 2014) of diabetes patients either exposed or unexposed to a GPMP. The primary end-point was the risk of first hospitalisation for a diabetes-related complication and was assessed using Cox proportional hazard regression models with death as a competing risk. Secondary end-points included rates of receiving guideline care for diabetes, with differences assessed using Poisson regression analyses.

Results: A total of 16 214 patients with diabetes were included; 8091 had a GPMP, and 8123 did not. After 1 year, 545 (6.7%) patients with a GPMP and 634 (7.8%) of patients without a GPMP were hospitalised for a diabetes complication. There was a 22% reduction in the risk of being hospitalised for a diabetes complication (adjusted hazard ratio (HR) 0.78, 95% confidence interval (CI) 0.69-0.87, P < 0.0001) for those who received a GPMP by comparison to those who did not. Increased rates of diabetes guideline care, HbA1c claims (adjusted HR 1.29, 95% CI 1.25-1.33) and microalbuminura claims (adjusted HR 1.65, 95% CI 1.58-1.72) were observed after a GPMP.

Conclusion: Provision of a GPMP in older patients with diabetes resulted in improved health outcomes, delaying the risk of hospitalisation at 12 months for diabetes complications. GPMP should be included as part of routine primary care for older patients with diabetes.

Item ID: 47488
Item Type: Article (Refereed Research - C1)
Keywords: diabetes, care plan, general practice, hospitalisation
ISSN: 1445-5994
Funders: Australian Research Council (ARC), National Health and Medical Research Council of Australia (NHMRC)
Projects and Grants: NHMRC ageing well ageing productively program grant
Date Deposited: 01 Mar 2017 07:32
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111702 Aged Health Care @ 100%
SEO Codes: 92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920104 Diabetes @ 100%
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