Relationship between number of contacts between previous dropouts with type 2 diabetes and health care professionals on glycaemic control: A cohort study in public primary health care

Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities

OBJECTIVE

This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities.

DESIGN AND SETTING

A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018.

SUBJECTS

PHC patients aged 60 years or more with a T2D were included.

MAIN OUTCOME MEASURES

Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR).

RESULTS

In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]).

CONCLUSIONS

In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities.Key PointsIn older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality.The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services.The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.

Planned primary health care asthma contacts during 12-year follow-up after Finnish National Asthma Programme: focus on spirometry

Primary health care (PHC) providers are at the front line of asthma management. To evaluate how planned asthma follow-up occurred in PHC and whether lung function tests were used, 203 patients were followed for 12 years as part of a real-life asthma cohort Seinäjoki Adult Asthma Study (SAAS). A total of 152 patients had visits in PHC attending on average to four planned contacts during 12-year follow-up corresponding to one visit every third year. National guideline recommends annual visits. Patients with ≥4 contacts seemed to have more difficult asthma and better adherence to inhaled corticosteroid medication. Lung function tests were performed on average in 87.5% of annual planned follow-up contacts. Spirometry was performed in 70%, 71% and 97% of all contacts depending on whether it was a contact to GP, nurse or both. Overall, the frequency of follow-up contacts was insufficient but PHC adherence to lung function testing was excellent.

A longitudinal follow-up study of a type 2 diabetes "lost to follow-up" cohort - positive effect on glycaemic control after changes in medication

The aim of this study was to evaluate whether patients with type 2 diabetes (T2D) who had stopped attending their diabetes treatment system (referred to as "lost to follow-up", LTF) but who succeeded in improving their glycaemic control after returning to the diabetes treatment system had changes in their diabetes medication when compared with similar patients who did not show improvement. "LTFs" who had baseline haemoglobin A_1 c (HbA_1 c) ≥53 mmol/mol and succeeded in reducing HbA_1 c ≥ 6 mmol/mol during a 12-30 month follow-up period after adhering again to their diabetes treatment system were compared with "LTFs" who had an unsatisfactory change in HbA_1 c or with "LTFs" who maintained good glycaemic control throughout the 12-30 month follow-up period. Unsatisfactory change in HbA_1 c was determined as HbA_1 c ≥ 53 mmol/mol and change <6 mmol/mol after the 12-30 month follow-up period in their diabetes treatment system or HbA_1 c < 53 mmol/mol when returning to the diabetes treatment system but ≥53 mmol/mol at the end of the 12-30 month follow-up period. "LTFs" with improvement in glycaemic control used a higher number of different anti-hyperglycaemic agents (P < 0.001) and their dosages of metformin increased (P < 0.05) when compared with "LTFs" without improvement or "LTFs" with satisfactory glycaemic control. Cholesterol-, LDL-cholesterol- and triglyceride-concentrations decreased during the 12-30 month follow-up period (P < 0.05) in "LTFs" with improved glycaemic control, but not in the other groups. "LTFs" with T2D who had poor glycaemic control seemed to require an increase in their anti-diabetic medication when attempting to improve their glycaemic control.