2 edition of Differences between primary and specialist care in the utilization of preventative medications for diabetic patients in Ontario. found in the catalog.
Differences between primary and specialist care in the utilization of preventative medications for diabetic patients in Ontario.
Baiju Ramnik Shah
Written in English
This dissertation examines differences in the utilization of medications to prevent diabetes complications, as a measure of quality of care, between Ontario diabetic patients who see specialists versus those whose care is from primary care physicians.First, the ability of Ontario administrative data to describe diabetes specialist use was validated. A questionnaire about physician utilization was administered to 781 participants from across Ontario, and their responses were compared with algorithms applied to their administrative data. The algorithm to identify whether patients received specialist care had good agreement with the questionnaire (80.9% agreement, kappa=0.59). The best algorithm to identify patients" regular primary care and specialist providers was concordant with self-report in 82.5% and 78.9% of cases, respectively.Administrative data were then used to compare preventative medication utilization between primary and specialist care. Glycemic control was better for diabetic patients with previous specialist care than patients with previous primary care, with mean A1c levels in matched cohorts of 7.9+/-1.5% and 8.3+/-2.0%, respectively (p<0.0001). This difference may have been driven in part by differences in glucose-lowering drug use. In response to A1c levels above 8%, 37.4% of primary care physicians" patients versus 45.1% of specialists" patients had some escalation in their glucose-lowering drug regimens within four months (p=0.009). Medications to modify cardiovascular risk factors were also prescribed differently. Compared to primary care physicians, the odds ratio for anti-hypertensive drug prescription was 1.27 (p<0.0001) for internists, and the odds ratio for lipid-lowering drugs was 1.58 (p<0.0001) for endocrinologists.Notwithstanding these differences in utilization between primary and specialist care, the most striking finding was that preventative medication utilization rates were low for all patients with diabetes, regardless of the specialty of their providers. Therefore, rather than further analyzing the differences between providers, future research should focus on improving diabetes care generally in the population.
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