H Hauner1, I Köster, L von Ferber. 1. Else-Kröner-Fresenius-Zentrum für Ernährungsmedizin der Technischen Universität Munich. hauner@wzw.tum.de
Abstract
AIM: Aim of this retrospective case-control study was to assess the quality of out-patient care in patients with diabetes mellitus by analysing health insurance data from a large cohort of members of a regional statutory health insurance fund in Hesse. METHODS: The study was carried out in the 'Versichertenstichprobe AOK Hessen/KV Hessen', a 18.75% random sample of the AOK Hesse, for the year 2001 corresponding to 306,736 subjects and 26,972 diabetics. All medical services and prescriptions provided by primary-care physicians were documented. RESULTS: Compared to an age- and sex-matched control group patients with diabetes received more out-patient medical services (diabetics: 126 +/- 0.8, controls: 76 +/- 0.4 per year, p < 0.0001) and more prescriptions (diabetics: 39.9 +/- 0.3, controls: 20.0 +/- 0.3 per year, p < 0.0001) in 2001. HbA (1c) measurements were performed in 69.5% of the insulin-treated patients, in 64.3% of the patients under monotherapy with oral hypoglycaemic agents and in 41.1% of the patients under dietary treatment. 78.1% of the insulin-treated patients, 12.0% of those under oral hypoglycaemic agents and 2.0% of patients under dietary treatment received prescriptions for material for blood glucose self-monitoring. In contrast, a retinal examination was performed in only 45.8%, 31.1% and 22.5% of the patients in the three treatment groups throughout the year. The respective figures for screening for microalbuminuria in the three treatment groups were 12.7%, 7.1% and 3.6%. CONCLUSIONS: The results of this retrospective analysis suggest that the out-patient medical care of subjects with diabetes is in some respect unsatisfactory and does not comply with the accepted recommendations for appropriate diabetes care.
AIM: Aim of this retrospective case-control study was to assess the quality of out-patient care in patients with diabetes mellitus by analysing health insurance data from a large cohort of members of a regional statutory health insurance fund in Hesse. METHODS: The study was carried out in the 'Versichertenstichprobe AOK Hessen/KV Hessen', a 18.75% random sample of the AOK Hesse, for the year 2001 corresponding to 306,736 subjects and 26,972 diabetics. All medical services and prescriptions provided by primary-care physicians were documented. RESULTS: Compared to an age- and sex-matched control group patients with diabetes received more out-patient medical services (diabetics: 126 +/- 0.8, controls: 76 +/- 0.4 per year, p < 0.0001) and more prescriptions (diabetics: 39.9 +/- 0.3, controls: 20.0 +/- 0.3 per year, p < 0.0001) in 2001. HbA (1c) measurements were performed in 69.5% of the insulin-treated patients, in 64.3% of the patients under monotherapy with oral hypoglycaemic agents and in 41.1% of the patients under dietary treatment. 78.1% of the insulin-treated patients, 12.0% of those under oral hypoglycaemic agents and 2.0% of patients under dietary treatment received prescriptions for material for blood glucose self-monitoring. In contrast, a retinal examination was performed in only 45.8%, 31.1% and 22.5% of the patients in the three treatment groups throughout the year. The respective figures for screening for microalbuminuria in the three treatment groups were 12.7%, 7.1% and 3.6%. CONCLUSIONS: The results of this retrospective analysis suggest that the out-patient medical care of subjects with diabetes is in some respect unsatisfactory and does not comply with the accepted recommendations for appropriate diabetes care.