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Open Access Research article

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

Janine C Malcolm129*, Julie Maranger23, Monica Taljaard34, Baiju Shah1056, Chetna Tailor1, Clare Liddy1789, Erin Keely129 and Teik Chye Ooi129

Author Affiliations

1 Department of Medicine, University of Ottawa, Ottawa, ON Canada

2 The Ottawa Hospital Research Institute, Ottawa, ON Canada

3 Clinical Epidemiology Program, Ottawa Hospital Research institute, Ottawa, ON Canada

4 Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON Canada

5 Department of Medicine, University of Toronto, Toronto Canada

6 Department of Medicine, Sunnybrook Health Sciences Centre, Toronto, ON Canada

7 Bruyere Research Institute, Ottawa, ON Canada

8 Department of Family Medicine, University of Ottawa, Ottawa, ON Canada

9 The Ottawa Hospital, Ottawa, ON Canada

10 Institute for Clinical Evaluative Sciences, Toronto, ON Canada

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BMC Health Services Research 2013, 13:303  doi:10.1186/1472-6963-13-303

Published: 10 August 2013

Abstract

Background

Continuity 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.

Methods

Retrospective 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).

Results

Retained 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.

Conclusions

Patients 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.