Analysis of the quality of health care for patients with type 2 diabetes enrolled in statutory or private health plans

摘要

BACKGROUND AND OBJECTIVE: Worldwide the quality of care of patients with type 2 diabetes has been investigated only by analysing within cross-sectional studies. But the quality of care in relation to statutory or private health plans in not known. It was the aim of this study to ascertain retrospectively, how in the course of time from first diagnosis the quality of medical care of patients with type 2 diabetes differed depending on the type of health insurance of the individual patient. METHODS AND PATIENTS: As part of the ROSSO study (a German retrospective epidemiological cohort study), data on all patients diagnosed with type 2 diabetes between 1.1.1995 and 31.12.1999 had been recorded. They had been collected from 192 randomly selected general practitioner or internal medicine specialist practices. RESULTS: The data of 3268 patients diagnosed with type 2 diabetes were recorded. The mean observation period was 6.5 years. The mean age of this patients at the time of diagnosis of diabetes was 62.4 +/- 9.6 years, 49 % being male. The portion of patients visiting their chosen practice at least 3 - 4 times in a given year was about 70 - 80 %. Documentation of HbA (1c) or blood pressure as requested in the guideline was presented in 20 - 50 % of patient files with no differences between enrolled in a statutory or private health plans. Even when cholesterol or blood pressure levels were greatly elevated 20 - 50 % of patients had been prescribed no adequate drug treatment. Only 20 % of the patients had been described platelet aggregation inhibitors during the first years after myocardial infarction or stroke. CONCLUSION: The quality of care in general practitioner of specialist internal medicine practices failed to meet the guidelines for patients with type 2 diabetes. There were no differences that depended on whether the patients had been enrolled in a statutory or private health plan.