1. Primary care and avoidable hospitalization for diabetes Michael van den Berg Tessa van Loenen (tessa.van.loenen@rivm.nl) PC and Diabetes hospitalization | 09/09/2013

2. The QUALICOPC project General objective: To evaluate European primary care systems on quality, equity and costs Hypothesis: The way primary care is organized in a country is related to: –How patients perceive the quality of pc –How providers deliver services –Overall health care outcomes (quality, equity and costs) PC and Diabetes hospitalization | 09/09/2013

3. The QUALICOPC project Three Surveys -Among random samples of GPs (around 220/country) -Among patients visiting GP practices (10/practice) -Among the field workers visiting GP practices (1/practice) PC and Diabetes hospitalization | 09/09/2013 More information on: www.qualicopc.eu

4. Workpackage: Avoidable hospital admissions ●Admission rates for ambulatory care sensitive conditions (ACSC) –Indicator for primary health care performance, quality and access ●Which admissions can be avoided? –Acute conditions –Adverse drugs events –Chronic conditions  Diabetes ●Objective: −Gain insight in relationships at country level between the structure and organization of primary care and the prevalence of avoidable hospitalizations for Diabetes PC and Diabetes hospitalization | 09/09/2013

5. Avoidable hospitalization: PC and Diabetes hospitalization | 09/09/2013 Source: OECD Health data 2011

6. Avoidable hospitalization: PC and Diabetes hospitalization | 09/09/2013

7. Avoidable hospital admissions and Primary care ●3 Primary care organizational characteristics: –Access ›Financial or geographical access, ooh-care, waiting times –Position primary care in health care system ›Central or marginal role, medical record keeping, referrals, continuity –Task profile ›Broad or small task profiles Hypothesis: Systems with easily accessible, central primary care with broad task profile have lower prevalence of avoidable hospitalization PC and Diabetes hospitalization | 09/09/2013

8. Methods Data sources: -QUALICOPC data: GP questionnaire and Patient questionnaire -OECD Health care quality indicators Analyses: -Analyses are based on 22 countries -Ecometrics for scale construction at country level -Simple regressions -multivariable regression with one control variable: Diabetes prevalence PC and Diabetes hospitalization | 09/09/2013

9. Results: Taskprofile PC and Diabetes hospitalization | 09/09/2013 CorrelationTreatment and follow up ActivitiesPreventionChronic care management Disease management program Long term complications -0.337-0.453**0.1320.1580.236 Uncontrolled diabetes -0.019-0.1300.0440.039-0.058 * p-value <0.1 ** p-value <0.05

10. Results: Taskprofile PC and Diabetes hospitalization | 09/09/2013

11. Results: Access PC and Diabetes hospitalization | 09/09/2013 CorrelationOut-of-Office hours Disadvantaged people Patient perceived access No restrictions to new patients Long term complications -0.3320.3190.355*0.379* Uncontrolled diabetes 0.1080.0190.0110.378 * p-value <0.1 ** p-value <0.05

12. Results: Access PC and Diabetes hospitalization | 09/09/2013

13. Results: Position of PC PC and Diabetes hospitalization | 09/09/2013 CorrelationCollaboration between GP and other professionals Continuity of care Long term complications -0.233-0.051 Uncontrolled diabetes -0.050-0.266

14. Discussion ●Based on these preliminary data: –Differences between countries can partly be explained by organization and structural differences –Diabetes prevalence : what other factors to take into account? ●Future steps: Include more countries –Update OECD data on avoidable hospitalization –Include more QUALICOPC countries PC and Diabetes hospitalization | 09/09/2013

16. Source: IDF 2012

17. Results: Position of PC PC and Diabetes hospitalization | 09/09/2013