Does delay in planned diabetes care influence outcomes for aboriginal Australians? A study of quality in health care.

ABSTRACT

BACKGROUND: To examine the association between delay in planned diabetes care and quality of outcomes. METHODS: A retrospective analysis of primary care and inpatient records for 2567 Aboriginal patients, with diabetes, living in 49 remote communities in the Northern Territory of Australia. Poisson regression was used to estimate the association between delay from diagnosis to documented diabetes care plan and three outcome measures: mean HbA1c level, most recent blood pressure and number of diabetes-related hospital admissions. RESULTS: Compared with no delay (< 60 days), patients with delay had increased risk of elevated mean HbA1c 60 days to < 2 years, incidence rate ratio (IRR), 1.2 (95% CI1.07-1.39); 2 years to < 4 years, incidence rate ratio (IRR), 1.2 (95% CI1.04-1.45); 4 years and over, incidence rate ratio (IRR), 1.3 (95% CI1.12-1.52). There was no evidence of association between delay and optimal blood pressure control. Risk of diabetes-related admission increased with increased delay. Compared with no delay the IRRs for delay were 60 days to < 2 years, 1.2 (95% CI1.07-1.42); 2 to < 4 years, 1.3 (95% CI 1.15-1.58) and 4 years and over, 2.6 (95% CI,2.28-3.08). CONCLUSION: The study found that a timely diabetes care plan was associated with better short-term blood glucose control and fewer diabetes-related admissions but not with improved blood pressure control. Delays may be a result of both patient and service-related factors.