Self-Monitoring of Blood Glucose: Guideline Application Rather than Utilization Restrictions on Testing Strips Has Potential to Reduce Diabetes Healthcare Costs in Italy
Self-Monitoring of Blood Glucose: Guideline Application Rather than Utilization Restrictions on Testing Strips Has Potential to Reduce Diabetes Healthcare Costs in Italy
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DOI：
10.1089/dia.2012.0116
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发表时间：
2012-10-01
影响因子：
5.4
通讯作者：
Ozzello, Alessandro
中科院分区：
文献类型：
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作者：
Giaccari, Andrea;Grassi, Giorgio;Ozzello, Alessandro
背景资料：自我血糖监测（SMBG）是改善血糖控制的有效工具，即使它可能会增加糖尿病管理的直接成本。在意大利，20个意大利地区中的每一个地区对每种患者类型的试纸的购买、处方规则和责任以及分配进行不同的管理。意大利糖尿病科学协会（Societa` Italiana Diabetologia [SID]和Associazione Medici Diabetologi [AMD]）已发布经验证的SMBG指南，但并非所有地区都适用。我们调查了遵循SID-AMD指南是否有助于降低意大利的SMBG和糖尿病医疗保健成本。材料和方法：我们比较了应用和不应用SMBG指南的地区使用的试纸平均数量、住院次数和住院次数。（主要诊断为糖尿病，不包括糖尿病并发症）和住院时间作为SMBG成本的间接指标。应用指南的地区记录的SMBG试纸使用率高于未应用指南的地区，但他们记录的糖尿病住院率更低（每100 000名居民住院36.2 +/- 11.3对79.9 +/- 27.8，P < 0.002），住院天数减少（每100，000名居民因糖尿病住院363 +/- 106 vs. 685 +/- 194天，P < 0.002）。我们的数据表明，SMBG处方指南的应用以及医疗服务提供者和区域卫生经济决策者之间的严格合作与SMBG试纸的更大利用率相关。它们还与糖尿病患者住院次数的显着减少和住院总时间的减少有关，可能节省医疗费用。
Background: Self-monitoring of blood glucose (SMBG) is a proven tool to improve glycemic control, even if it might increase direct costs for diabetes management. In Italy, the purchase, prescription rules and responsibilities, and distribution of testing strips per type of patient are managed differently in each of the 20 Italian regions. The Italian scientific societies for diabetes (Societa` Italiana Diabetologia [SID] and Associazione Medici Diabetologi [AMD]) have issued validated guidelines for SMBG, but not all regions apply them. We investigated whether following SID-AMD guidelines would help decreasing SMBG and diabetes healthcare costs in Italy.Materials and Methods: We compared the regions applying and not applying SMBG guidelines for the mean number of testing strips used, number of hospitalizations (with the principal diagnosis of diabetes, excluding diabetes complications), and duration of hospitalization, as indirect measures of SMBG cost.Results: Regions applying the guidelines recorded higher SMBG testing strip utilization than regions not applying guidelines, but they recorded fewer hospitalizations for diabetes (36.2 +/- 11.3 vs. 79.9 +/- 27.8 hospitalizations per 100,000 inhabitants, P < 0.002) and fewer days in the hospital (363 +/- 106 vs. 685 +/- 194 days of hospitalization for diabetes per 100,000 inhabitants, P < 0.002).Conclusions: Our data suggest that application of guidelines for SMBG prescription and a strict cooperation between health providers and regional health economic deciders were associated with greater utilization of SMBG testing strips. They were also associated with significantly reduced number of hospitalizations and reduced overall duration of hospitalization for patients with diabetes, potentially saving healthcare costs.