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Comparative Study
. 2017 Aug 7;17(1):533.
doi: 10.1186/s12913-017-2486-7.

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels

Sokha Sieng  1   2   3 , Cameron Hurst  4   5
Affiliations
Comparative Study

A combination of process of care and clinical target among type 2 diabetes mellitus patients in general medical clinics and specialist diabetes clinics at hospital levels

Sokha Sieng et al. BMC Health Serv Res. .

Abstract

Background: This study compares a combination of processes of care and clinical targets among patients with type 2 diabetes mellitus (T2DM) between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how differences between these two types of clinics differ with hospital type (community, provincial and regional).

Methods: Type 2 diabetes mellitus patient medical records were collected from 595 hospitals (499 community, 70 provincial, 26 regional) in Thailand between April 1 to June 30, 2012 resulting in a cross-sectional sample of 26,860 patients. Generalized linear mixed modeling was conducted to examine associations between clinic type and quality of care. The outcome variables of interest were split into clinical targets and process of care. A subsequent subgroup analysis was conducted to examine if the nature of clinical target and process of care differences between GMCs and SDCs varied with hospital type (regional, provincial, community).

Results: Regardless of the types of hospitals (regional, provincial, or community) patients attending SDCs were considerably more likely to have eye and foot exam. In terms of larger hospitals (regional and provincial) patients attending SDCs were more likely to achieve HbA1c exam, All FACE exam, BP target, and the Num7Q. Interestingly, SDCs performed better than GMCs at only provincial hospitals for LDL-C target and the All7Q. Finally, patients with T2DM who attended community hospital-GMCs had a better chance of achieving the blood pressure target than patients who attended community hospital-SDCs.

Conclusions: Specialized diabetes clinics outperform general medical clinics for both regional and provincial hospitals for all quality of care indicators and the number of quality of care indicators achieved was never lower. However, this better performance of SDC was not observed in community hospital. Indeed, GMCs outperformed SDCs for some quality of care indicators in the community level setting.

Keywords: General medical clinics; Hospital levels; Quality of care; Specialist diabetes clinics; Type 2 diabetes mellitus.

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Conflict of interest statement

Ethics approval and consent to participate

Ethical clearance was obtained from the Khon Kaen University Ethics Committee for Human Research Based on the Declaration of Helsinki and the ICH Good Clinical Practice Guideline, Record No.3.4.01:34/2013 and Reference No.HE562215. Permission to conduct the study was obtained from Thailand Medical Research Network (MedResNet) while written informed consent was obtained from the respondents participating in the study.

Consent for publication

All respondents provided signed informed consent to participate in which they agreed with the anonymous use of the data obtained in the study for publication.

Competing interests

The authors declare that they have no financial or personal relationship(s) which may have inappropriately influenced them in writing this paper.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

References

    1. Shaw JE, Sicree RA, Zimmet PZ. Global estimates of the prevalence of diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:4–14. doi: 10.1016/j.diabres.2009.10.007. - DOI - PubMed
    1. Whiting DR, Guariguata L, Weil C, Shaw J. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract. 2011;94:311–321. doi: 10.1016/j.diabres.2011.10.029. - DOI - PubMed
    1. Zhang P, Zhang X, Brown J, Vistisen D, Sicree R, Shaw J, et al. Global healthcare expenditure on diabetes for 2010 and 2030. Diabetes Res Clin Pract. 2010;87:293–301. doi: 10.1016/j.diabres.2010.01.026. - DOI - PubMed
    1. Sieng S, Thinkamrop B, Laohasiriwong W, Hurst C. Comparison of HbA1c, blood pressure, and cholesterol (ABC) control in type 2 diabetes attending general medical clinics and specialist diabetes clinics in Thailand. Diabetes Res Clin Pract. 2015;108:265–272. doi: 10.1016/j.diabres.2015.02.005. - DOI - PubMed
    1. Sieng S, B Thinkamrop, Hurst C, "Achievement of Processes of Care for Patients with Type 2 Diabetes in General Medical Clinics and Specialist Diabetes Clinics in Thailand," Epidemiology: Open Access. 2015;5:S2.

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