Variation between general practitioners in type 2 diabetes processes of care

Kjersti Nøkleby; Tore Julsrud Berg; Ibrahimu Mdala; Anh Thi Tran; Åsne Bakke; Bjørn Gjelsvik; Tor Claudi; John G Cooper; Karianne F Løvaas; Geir Thue; Sverre Sandberg; Anne K Jenum

doi:10.1016/j.pcd.2020.11.018

Variation between general practitioners in type 2 diabetes processes of care

Prim Care Diabetes. 2021 Jun;15(3):495-501. doi: 10.1016/j.pcd.2020.11.018. Epub 2021 Jan 19.

Authors

Affiliations

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.

PMID: 33349599
DOI: 10.1016/j.pcd.2020.11.018

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.

Keywords: Diabetes mellitus, type 2; General practice; General practitioners; Guideline adherence; Primary health care; Process assessment, health care; Quality improvement; Quality indicators, health care.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Attitude of Health Personnel
Cross-Sectional Studies
Diabetes Mellitus, Type 2* / diagnosis
Diabetes Mellitus, Type 2* / epidemiology
Diabetes Mellitus, Type 2* / therapy
General Practitioners*
Humans
Middle Aged
Practice Patterns, Physicians'
Workload