Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter?
Global health care use by patients with type-2 diabetes: Does the type of comorbidity matter?
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DOI：
10.1016/j.ejim.2015.02.011
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发表时间：
2015-03-27
影响因子：
8
通讯作者：
Prados-Torres, A.
中科院分区：
文献类型：
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作者：
Calderon-Larranaga, A.;Abad-Diez, J. M.;Prados-Torres, A.
目的：为了确定模式的医疗保健使用的糖尿病患者之间的多morphies跨初级，专科，医院和急诊，根据其类型的慢性comorphis.Methods：一个基于人群的回顾性队列的纵向研究符合成人2型糖尿病患者分配到任何初级保健中心在阿拉贡在2010年和2011年（n = 65,716）。进行负二项回归，以模拟合并症类型对各级护理就诊次数的影响。根据专家共识以及是否具有相同的总体病理生理风险特征和针对2型糖尿病设计的疾病管理计划，将合并症分为一致性、不一致性或精神性。（发生率比[IRR]：1.25; 95%置信区间[CI]：1.12 - 1.39，IRR：1.21; 95% CI：1.06 - 1.39），平均住院时间（IRR：1.47; 95% CI：1.25 - 1.73）以及总急诊室访视和优先急诊室访视（IRR：1.26; 95% CI：1.17 - 1.35，IRR：1.30; 95% CI：1.18 - 1.42）。患有不一致合并症的患者与专家就诊次数（IRR：1.38; 95% CI：1.33 - 1.43）和不同专业（IRR：1.36; 95% CI：1.32 - 1.39）的相关性最强。GP访视的差异较低，但对于合并症不一致的患者仍有显著性（IRR：1.08; 95% CI：1.06 - 1.11），但尤其是精神共病患者（IRR：1.17; 95% CI：1.14 - 1.21）。在2型糖尿病患者中，精神共病的共存显著增加了计划外医院服务的使用，不一致的合并症对专科护理的使用有重要影响。初级保健使用方面的差异并不突出。(C)2015年欧洲内科联盟。Elsevier B.V.出版，保留所有权利。
Aim: To identify patterns of health care use among diabetic patients with multimorbidity across primary, specialised, hospital and emergency care, depending on their type of chronic comorbidity.Methods: Longitudinal study of a population-based retrospective cohort conformed by adult patients with type-2 diabetes assigned to any of the primary care centres in Aragon during 2010 and 2011 (n = 65,716). Negative binomial regressions were run to model the effect of the type of comorbidity on the number of visits to each level of care. Comorbidities were classified as concordant, discordant or mental based on expert consensus and depending on whether they shared the same overall pathophysiologic risk profile and disease management plan designed for type-2 diabetes.Results: Mental comorbidity was independently associated with total and unplanned admissions (incidence rate ratio [IRR]: 1.25; 95% confidence interval [CI]: 1.12-1.39, IRR: 1.21; 95% CI: 1.06-1.39), average length of stay (IRR: 1.47; 95% CI: 1.25-1.73), and total and priority emergency room visits (IRR: 1.26; 95% CI: 1.17-1.35, IRR: 1.30; 95% CI: 1.18-1.42). Patients with discordant comorbidities showed the strongest associations with the number of visits to specialists (IRR: 1.38; 95% CI: 1.33-1.43) and to different specialties (IRR: 1.36; 95% CI: 1.32-1.39). Differences regarding GP visits were lower but still significant for patients with discordant comorbidity (IRR: 1.08; 95% CI: 1.06-1.11), but especially for those with mental comorbidity (IRR: 1.17; 95% CI: 1.14-1.21).Conclusion: In patients with type-2 diabetes, the coexistence of mental comorbidity significantly increases the use of unplanned hospital services, and discordant comorbidities have an important effect on specialised care use. Differences with respect to primary care use are not as prominent. (C) 2015 European Federation of Internal Medicine. Published by Elsevier B.V. All rights reserved.