The study will examine the reach of incentives to improve PHC provision to patients with diabetes and the impact of improved care on outcomes such as hospitalisation.

Project Short Title

Diabetes Linkage Study

Project Number

RMO7510

Project Status

Completed Projects

Chief Investigators

Elizabeth Comino, Mark Harris, Louisa Jorm, Marion Haas, Jeff Flack, Bin Jalaludin, Kris Rogers, Gawaine Powell Davies

Other Team Members

Yordanka Krastev, Danielle Tran

Rationale

In Australia most people access health care through community based primary care settings such as general practice, community health services, pharmacy, and allied health. In these settings care may be fragmented due to the range of health professionals involved, mix of private and public funding and practice, number of stakeholders with funding responsibility, and mix of fee-for-service and salaried staff. Because there is no comprehensive source of data on service use in this setting, primary care is underrepresented in health statistics, and there has been limited exploration of processes of care for people with chronic health care needs. Current initiatives to increase the availability and use of administrative data collections provide important opportunities to explore processes of primary health care (PHC) using record linkage. Diabetes is a significant chronic disease that is managed largely in the PHC setting. It has a prevalence now approaching 12.7% in people over 45 years of age, and is associated with more frequent use of health services and poorer outcomes following surgery and other procedures. Research has identified the elements of best practice diabetes management, helped clinicians reach consensus on processes of care for people with diabetes and led to the publication of management guidelines suitable for implementation in PHC settings. For the purpose of this research we defined "best practice" as recommended processes of care according to widely accepted evidence based diabetes management guidelines.

Aims

1. Describe processes of primary health care provision for older people with diabetes,

2. Identify the predictors of provision of primary health care

3. Explore the relationship between primary health care (best practice or otherwise) and measures of health outcomes including quality of life and hospitalisation

Design and Method

This is cohort study involving data linkage. The sources of data are:

1. 45 and Up Study: participants with diabetes (n=24 000) and a matching sample without diabetes (age, sex and recruitment date).

2. Diabetes Risk Factor Survey: (n~ 2000) participants with diabetes recruited during 2008.

3. Medicare Australia

  • Medical Benefits Scheme (MBS)
  • Pharmaceutical Benefits Scheme (PBS)

4. NSW Health

  • Admitted Patient Data Collection (APDC)- records for all hospital separations from all NSW public and private sector hospitals and day procedure centres.
  •  Emergency Department Data Collection (EDDC) - records for all emergency events (arrival, departure, and clinical data) from all NSW Emergency Departments.

5. NSW Registry of Births, Deaths and Marriages (RBDM) - death registrations for NSW
Outcome factors:

  •  processes of care provision (MBS and PBS data)
  • hospitalisation (APDC and EDDC data)
  • deaths (RBDM data)

Study factors:

  • demographic characteristics,
  • behavioural risk factors,
  • health status and
  • socio-economic status

Descriptive analysis will examine relationship between best practice PHC and hospitalisation and death.
The study will enable examination of the reach of incentives to improve PHC provision to patients with diabetes and the impact of improved care on outcomes such as hospitalisation. It will provide important insight into the relationship between clinical care in community based settings such as general practice and outcomes such as hospitalisation. The information is of interest to health researchers, policy makers, and the wider community. It will also inform strategies to integrate primary health care across state and national jurisdictions and support more effective access to multidisciplinary care for people with chronic conditions.

Contact

Elizabeth Comino Email: e.comino@unsw.edu.au

Key Partners

Sax Institute

Funding

NHMRC

Project lead centre
CPHCE
Project stream
Health System Integration and Primary Health Care Development
Project start date
2010
Project end date
2013