Primary care networks may improve diabetes management
MedWire News: Patients with diabetes managed in primary care networks receive better care and have improved clinical outcomes compared with those managed outside of networks, a Canadian study suggests.
The primary care network management of diabetes was associated with a 20% relative reduction in admissions to hospital or visits to emergency departments for hypoglycemia or hyperglycemia, report Braden Manns (University of Calgary, Alberta) and colleagues in the Canadian Medical Association Journal.
The study looked at administrative healthcare data on patients in Alberta, where primary care networks were implemented in 2005. Main objectives of the networks were to improve access to primary care services; emphasize the promotion of health, prevention of disease and injury, and care of patients with medically complex problems of chronic disease; improve the coordination of primary care services with hospitals; and foster a team approach to primary care provision.
The team compared outcomes for 77,830 patients with prevalent diabetes whose condition was managed in one of 18 primary care networks and 105,824 not enrolled in one of the networks.
Analysis of the patients after propensity score matching showed that those managed in primary care networks were less likely to be admitted to hospital or to visit an emergency department for a diabetes-specific ambulatory care sensitive condition over 1 year of follow-up, at adjusted incidence risk ratio of 0.81.
However, this relative change represented a small absolute risk difference of 0.67 per 1000 patient months, the authors note.
Patients in the primary care network group were also more likely to undergo guideline-recommended laboratory investigations and retinal screening, and had slightly lower mean glycated hemoglobin levels. Among patients aged 66 years or older, the primary care network-managed patients were more likely to receive statins than those not enrolled in a network.
Manns and team caution that the study was not randomized and that further confounding variables may still explain some of the effect found.
In addition, administrative databases lack data on elements of care patients receive and patient-level outcomes including bodyweight, blood pressure, or patient satisfaction. And, they add, the management programs currently used vary substantially across different networks.
Nevertheless, they write: "Despite these limitations, our population-based study reflects real-world experience with primary care networks in a large area served by a universal healthcare system, with careful assessment of both evidence- and process-based outcomes."
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By Caroline Price