Kjersti Nøkleby1, Tore Julsrud Berg2, Ibrahimu Mdala3, Anh Thi Tran3, Åsne Bakke4, Bjørn Gjelsvik3, Tor Claudi5, John G Cooper6, Karianne F Løvaas7, Geir Thue8, Sverre Sandberg9, Anne K Jenum10. 1. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. Electronic address: kjersti.nokleby@medisin.uio.no. 2. Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway; Department of Endocrinology, Morbid Obesity and Preventive Medicine, Oslo University Hospital, Oslo, Norway. 3. Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway. 4. Department of Medicine, Stavanger University Hospital, Stavanger, Norway. 5. Nordland Hospital, Department of Medicine, Bodø, Norway. 6. Department of Medicine, Stavanger University Hospital, Stavanger, Norway; Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway. 7. Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway. 8. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway. 9. Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway; Norwegian Quality Improvement of Laboratory Examinations, Haraldsplass Deaconess Hospital, Bergen, Norway; Department of Medical Biochemistry and Pharmacology, Haukeland University Hospital, Bergen, Norway. 10. General Practice Research Unit (AFE), Department of General Practice, Institute of Health and Society, University of Oslo, Oslo, Norway.
Abstract
AIMS: To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetes patients <75 years without cardiovascular disease. METHODS: Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. RESULTS: We identified 6015 type 2 diabetes patients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37-4.92). GPs' age >60 years and heavier workload were associated with poorer performance. CONCLUSION: We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.
AIMS: To explore variation in general practitioners' (GPs') performance of six recommended procedures in type 2 diabetespatients <75 years without cardiovascular disease. METHODS: Cross-sectional study of quality of diabetes care in Norway based on electronic health records from 2014. GPs (clustered in practices) were divided in quintiles based on a composite measure of performance of six processes of care. We fitted a multilevel partial ordinal regression model to identify GP factors associated with being in quintiles with better performance. RESULTS: We identified 6015 type 2 diabetespatients from 275 GPs in 77 practices. The GPs performed on average 63.4% of the procedures; on average 46% in the poorest quintile to 81% in the best quintile with a larger range in individual GPs. After adjustments, use of a structured follow-up form was associated with GPs being in upper three quintiles (OR 12.4 (95% CI 2.37-65.1). Routines for reminders were associated with being in a better quintile (OR 2.6 (1.37-4.92). GPs' age >60 years and heavier workload were associated with poorer performance. CONCLUSION: We found large variations in GPs' performance of processes of care. Factors reflecting structure and workload were strongly associated with performance.
Keywords:
Diabetes mellitus, type 2; General practice; General practitioners; Guideline adherence; Primary health care; Process assessment, health care; Quality improvement; Quality indicators, health care
Authors: Sara Guillen-Aguinaga; Luis Forga; Antonio Brugos-Larumbe; Francisco Guillen-Grima; Laura Guillen-Aguinaga; Ines Aguinaga-Ontoso Journal: J Clin Med Date: 2021-12-14 Impact factor: 4.241