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Abstract
Objectives To describe primary care utilisation patterns among adults with type 2 diabetes and to quantify the association between utilisation and long-term health outcomes.
Design Retrospective cohort study.
Setting 168 primary care practices in Southern England within the Electronic Care and Health Information Analytics database between 2013 and 2020.
Participants 110 240 adults with Quality and Outcomes Framework read code of type 2 diabetes diagnosis; age greater than 18 years; linked and continuous records available from April 2013 until April 2020 (or death).
Primary and secondary outcome measures (1) Rates of service utilisation (total number of primary care contacts per quarter) across the study period; (2) participant characteristics associated with higher and lower rates of service utilisation; and (3) associations between service utilisation and (A) cardiovascular disease (CVD events) and (B) all-cause mortality.
Results Mean (SD) number of primary care attendances per quarter in the cohort of 110 240 went from 2.49 (2.01) in 2013 to 2.78 (2.06) in 2020. Patients in the highest usage tertile were more likely to be female, older, more frail, white, from the least deprived quintile and to have five or more comorbidities. In adjusted models, higher rates of service utilisation (per consultation) were associated with higher rates of CVD events (OR 1.0058; 95% CI 1.0053 to 1.0062; p<0.001) and mortality (OR 1.0057; 95% CI 1.0051 to 1.0064; p<0.001).
Conclusions People with type 2 diabetes are using primary care services more frequently, but increased volume of clinical care does not correlate with better outcomes, although this finding may be driven by more unwell patients contacting services more frequently. Further research on the nature and content of contacts is required to understand how to tailor services to deliver effective care to those at greatest risk of complications.
- primary care
- general diabetes
- organisation of health services
Data availability statement
Data may be obtained from a third party and are not publicly available. Access to the dataset used for this research is governed by the Hampshire Health Record (Care and Health Information Exchange), which has its own independent panel for ethics and governance approval and data access. More information on their procedures can be found here: https://careandhealthinformationexchange.org.uk/wp-content/uploads/2018/04/CHIE-Review-of-Procedures-Compliance-with-GDPR_V5-1.pdf.
This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.
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Data availability statement
Data may be obtained from a third party and are not publicly available. Access to the dataset used for this research is governed by the Hampshire Health Record (Care and Health Information Exchange), which has its own independent panel for ethics and governance approval and data access. More information on their procedures can be found here: https://careandhealthinformationexchange.org.uk/wp-content/uploads/2018/04/CHIE-Review-of-Procedures-Compliance-with-GDPR_V5-1.pdf.
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Footnotes
Twitter @samcbhodgson
Contributors HD-M designed the study, wrote the first draft of the paper, edited and contributed to subsequent versions. SH analysed the data and drafted and revised subsequent versions of the paper. JM-H carried out data analysis and revised the paper. HH revised the paper. BS provided advice on statistical methods and revised the paper. HDM is guarantor.
Funding HD-M is a National Institute for Health Research (NIHR) funded Academic Clinical Lecturer and has received NIHR School of Primary Care Research funding to support this work (SPCR2014-10043). SH is an Academic Clinical Fellow funded by the NIHR.
Disclaimer The views and opinions expressed by authors in this publication are those of the authors and do not necessarily reflect those of the UK NIHR or the Department of Health and Social Care.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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