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Open Access Research article

Type II diabetes patients in primary care: profiles of healthcare utilization obtained from observational data

Christel E van Dijk1*, Trynke Hoekstra23, Robert A Verheij1, Jos WR Twisk23, Peter P Groenewegen14, François G Schellevis15 and Dinny H de Bakker16

Author affiliations

1 NIVEL, Netherlands Institute for Health Services Research, P.O.Box 1568, Utrecht, 3500 BN, The Netherlands

2 VU University, Faculty of Earth- and Life Sciences, Department of Health Sciences and the EMGO Institute for Health and Care Research, Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands

3 VU University medical center, Department of Epidemiology and Biostatistics and the EMGO Institute for Health and Care Research, Boelelaan 1085, Amsterdam, 1081 HV, The Netherlands

4 Utrecht University, Department of Sociology, Department of Human Geography, P.O.Box 80140, Utrecht, 3508 TC, The Netherlands

5 VU University medical center, Department of General Practice and the EMGO Institute for Health and Care Research, Van der Boechorstraat 7, Amsterdam, 1081 BT, The Netherlands

6 Tilburg University, Scientific Centre for Transformation in Care and Welfare (TRANZO), Tilburg 90153, 5037 AB, The Netherlands

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Citation and License

BMC Health Services Research 2013, 13:7  doi:10.1186/1472-6963-13-7

Published: 4 January 2013

Abstract

Background

The high burden of diabetes for healthcare costs and their impact on quality of life and management of the disease have triggered the design and introduction of disease management programmes (DMPs) in many countries. The extent to which diabetes patients vary with regard to their healthcare utilisation and costs is largely unknown and could impact on the design of DMPs. The objectives of this study are to develop profiles based on both the diabetes-related healthcare utilisation and total healthcare utilisation in primary care, to investigate which patient and disease characteristics determine ‘membership’ of each profile, and to investigate the association between these profiles.

Methods

Data were used from electronic medical records of 6721 known type II diabetes patients listed in 48 Dutch general practices. Latent Class Analyses were conducted to identify profiles of healthcare and regression analyses were used to analyse the characteristics of the profiles.

Results

For both diabetes-related healthcare utilisation and total healthcare utilisation three profiles could be distinguished: for the diabetes-related healthcare utilisation these were characterised as ‘high utilisation and frequent home visits’ (n=393), ‘low utilisation, GP only’ (n=3231) and ‘high utilisation, GP and nurse’ (n=3097). Profiles differed with respect to the patients’ age and type of medication; the oldest patients using insulin were dominant in the ‘high utilisation, GP and nurse’ profile. High total healthcare utilisation was not associated with high diabetes-related healthcare utilisation.

Conclusions

Healthcare utilisation of diabetes patients is heterogeneous. This challenges the development of distinguishable DMPs.

Keywords:
Type II diabetes mellitus; Healthcare utilisation profiles; Primary care; Latent Class Analyses