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Determinants of inappropriate setting allocation in the care of patients with type 2 diabetes: A population-based study in Reggio Emilia province.
Ballotari, Paola; Venturelli, Francesco; Manicardi, Valeria; Vicentini, Massimo; Ferrari, Francesca; Greci, Marina; Maiorana, Mariarosa; Rossi, Paolo Giorgi.
Afiliación
  • Ballotari P; Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Venturelli F; Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Manicardi V; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy.
  • Vicentini M; Diabetes Clinic, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Ferrari F; Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Greci M; Epidemiology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Maiorana M; Department of Primary Care, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
  • Rossi PG; Nephrology Unit, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy.
PLoS One ; 14(7): e0219965, 2019.
Article en En | MEDLINE | ID: mdl-31329611
ABSTRACT
The study aims to describe the distribution of patients with type 2 diabetes (T2D) by care plan and to highlight determinants of underuse and overuse of integrated care (IC). This cross-sectional study included all T2D patients resident in Reggio Emilia on 31/12/2015 based on the population-based diabetes registry. Eligibility for IC requires good glycaemic control, no rapid insulin, no kidney failure and no diabetes complications. We calculated the proportion of IC underuse and overuse and adjusted prevalence estimate using multivariate logistic regression. Determinants were age, sex, citizenship, district of residence and time since diagnosis. Of 29,776 patients, 15,364 (51.6%) were in diabetes clinic plan, 9851 (33.1%) in IC plan and 4561 (15.3%) not in any care plan (i.e., in Other group). There were 10,906 (36.6%) patients eligible for IC, of whom 1000 in Other group. When we adjusted for all covariates and restricted the analysis to patients included in care plans, the proportion of those eligible for IC plan but cared for in diabetes clinic plan (i.e. underuse of IC) was 28% (n = 3028/9906; 95%CI 27-29). Similarly, the proportion of those not eligible for IC but cared for in IC plan (i.e. overuse of IC) was 11% (n = 1720/11,896; 95%CI 10-11).The main determinant of both IC underuse and overuse was the district of residence. Foreign status was associated with underuse (37%; 95%CI 33-43), while old age (≥80 years) with both underuse (36%; 95%CI 0.33-0.38) and overuse (23%; 95%CI 22-25). The criterion for suspension of IC plan most frequently found was renal failure, followed by hospitalization for diabetes-related complications. Patients are more often allocated to more specialized settings than not. Healthcare provider-related factors are the main determinants of inappropriate setting allocation.
Asunto(s)

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Prestación Integrada de Atención de Salud / Diabetes Mellitus Tipo 2 / Mal Uso de los Servicios de Salud Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2019 Tipo del documento: Article País de afiliación: Italia

Texto completo: 1 Base de datos: MEDLINE Asunto principal: Prestación Integrada de Atención de Salud / Diabetes Mellitus Tipo 2 / Mal Uso de los Servicios de Salud Tipo de estudio: Guideline / Observational_studies / Risk_factors_studies Límite: Aged / Aged80 / Female / Humans / Male / Middle aged País/Región como asunto: Europa Idioma: En Revista: PLoS One Asunto de la revista: CIENCIA / MEDICINA Año: 2019 Tipo del documento: Article País de afiliación: Italia