RESUMO
AIM: The aim of this observational study was to assess mortality of patients with type 2 diabetes by type of healthcare delivery system, i.e. through specialist centers or generalist doctors, or integrated care. METHODS: The study was conducted at the "Vicentino Ovest" Local Health District in the Veneto Region (north-eastern Italy) from January 1, 2008 to December 31, 2010. Patients with diabetes (≥ 20 years old) were identified using different public health databases. They were grouped as: patients followed up by specialists at diabetes clinics (DS); patients seen only by their own general practitioner (GP); and patients receiving integrated care (DS-GP). Cox's regression analysis was used to estimate adjusted hazard ratios for available potential predictors of death by level of care. RESULTS: The crude mortality rate was highest in the GP group (26.1 per 1000 person-years), the difference being minimal when compared with the DS group (21.7 per 1000 person-years) and more marked when compared with the DS-GP group (8.8 per 1000 person-years). Patients followed up by their GPs had a 2.7 adjusted RR for mortality by comparison with the DS-GP group. CONCLUSIONS: The findings of the present study could demonstrate that it is safe and cost-effective, after a first specialist assessment at a diabetes service, for low-risk diabetic patients to be managed by family physicians as part of a coordinated care approach, based on the specialist's clinical recommendations; GPs can subsequently refer patients to a specialist whenever warranted by their clinical condition.
Assuntos
Prestação Integrada de Cuidados de Saúde , Diabetes Mellitus Tipo 2/terapia , Medicina Geral , Programas de Assistência Gerenciada , Encaminhamento e Consulta , Especialização , Adolescente , Adulto , Idoso , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/mortalidade , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Itália/epidemiologia , Masculino , Pessoa de Meia-Idade , Equipe de Assistência ao Paciente , Modelos de Riscos Proporcionais , Fatores de Risco , Resultado do Tratamento , Adulto JovemRESUMO
The authors study the prevalence of lost of the first permanent molars in 6 to 12 years old schoolchildren of medium and low social-economic levels, in both sexes, from Ribeirão Preto, SP., on right and left hemiarcs, and both maxilars. The results indicate that teeth los was significantly higher in females, and in both sexes the teeth lost was higher in the lower maxilar. No differences were also observed between hemiarchs.