Assessment of a project for integrated management of care given to patients with type-2 diabetes in the Local Health Authority 21 of Legnago (Veneto Region, Northern Italy) in the period 2010-2012

作者：Marcon Alessandro^*; Vaona Alberto; Rigon Giulio; Carazzolo Marco; Del Zotti Franco; Girotto Sandro; Marafetti Claudio

来源：Epidemiologia e Prevenzione, 2016, 40(5): 344-354.

DOI：10.19191/EP16.5.P344.109

• type-2 diabetes
• family physicians
• integrated health care
• administrative data
• primary care

OBJECTIVES: to describe, in the Local Health Authority (LHA) 21 of Legnago (Veneto Region, Northern Italy), the trends that occurred in several health indicators between 2009, the year before the implementation of a project of integrated management of care given to patients with type-2 diabetes, and 2012, the last year of this project. DESIGN: longitudinal repeated cross-sectional study.
SETTING AND PARTICIPANTS: all type-2 diabetes patients identified using administrative health data (based on payment exemptions, referrals to diabetes centres, use of antidiabetic drugs, and glucose monitoring strips) and family physician medical records.
MAIN OUTCOME MEASURES: number of diagnostic and follow-up tests provided, use of medicines, specialist care examinations, emergency department and hospital admissions, and mortality.
RESULTS: despite the general decline (-3.1%) in the number of tests provided by LHA 21 during the period 20092012, the analysis documented a marked increase in the examinations included in the management of diabetes, namely oral glucose tolerance tests (+104.3%), glycated haemoglobin (+19.0%), and microalbuminuria (+296.1%). The subjects identified as having diabetes increased from 8,084 in 2009 (5.2%) to 9,221 in 2012 (5.9%). Increases in the prevalence of patients attending the diabetes centres (from 22.6% to 39.0%) and of patients treated with metformin (from 28.0% to 37.5%), insulines (from 13.5% to 18.3%), and incretines (from 1.4% to 9.0%) were observed. Sulfonylureas users decreased (from 49.9% to 40.8%), as well as the prevalence of patients examined by specialists and of patients admitted to the emergency department or hospital, whereas mortality rates were stable (29.6 deaths x1,000/year).
CONCLUSION: during the period of implementation of the project, increases in diagnostic sensitivity and diabetic patient care seem to have occurred. Although the observational design of this study cannot prove a cause-effect relationship, these findings seem to support the hypothesis that the integrated management of diabetes improves the appropriateness of medical care.

• 出版日期2016-10