Need and disparities in primary care management of patients with diabetes
1 Department of Molecular Medicine of the University of Padova, Laboratory of Public Health and Population Studies, Via Loredan, 18, 35100 Padova, Italy
2 Toscana Region Healthcare Agency, Florence 50100, Italy
3 Healthcare Organization Department, National Health Agency, Rome 00100, Italy
4 Catholic University of Sacred Heart, Rome 00100, Italy
5 University of Cassino and Southern Lazio, Cassino 03043, Italy
6 Local Health Unit 16 Padua, Veneto Region, Padua 35100, Italy
7 Zona Territoriale Senigallia, Regione Marche, Senigallia 60019, Italy
8 Regione Emilia Romagna, Bologna 40100, Italy
9 ASP 7 Ragusa, Regione Sicilia, Ragusa 97100, Italy
BMC Endocrine Disorders 2014, 14:56 doi:10.1186/1472-6823-14-56Published: 10 July 2014
An aging population means that chronic illnesses, such as diabetes, are becoming more prevalent and demands for care are rising. Members of primary care teams should organize and coordinate patient care with a view to improving quality of care and impartial adherence to evidence-based practices for all patients. The aims of the present study were: to ascertain the prevalence of diabetes in an Italian population, stratified by age, gender and citizenship; and to identify the rate of compliance with recommended guidelines for monitoring diabetes, to see whether disparities exist in the quality of diabetes patient management.
A population-based analysis was performed on a dataset obtained by processing public health administration databases. The presence of diabetes and compliance with standards of care were estimated using appropriate algorithms. A multilevel logistic regression analysis was applied to assess factors affecting compliance with standards of care.
1,948,622 Italians aged 16+ were included in the study. In this population, 105,987 subjects were identified as having diabetes on January 1st, 2009. The prevalence of diabetes was 5.43% (95% CI 5.33-5.54) overall, 5.87% (95% CI 5.82-5.92) among males, and 5.05% (95% CI 5.00-5.09) among females. HbA1c levels had been tested in 60.50% of our diabetic subjects, LDL cholesterol levels in 57.50%, and creatinine levels in 63.27%, but only 44.19% of the diabetic individuals had undergone a comprehensive assessment during one year of care. Statistical differences in diabetes care management emerged relating to gender, age, diagnostic latency period, comorbidity and citizenship.
Process management indicators need to be used not only for the overall assessment of health care processes, but also to monitor disparities in the provision of health care.