Use of primary health care services and mortality in older patients with type 2 diabetes with or without comorbidities.

IF 1.9 3区医学 Q3 HEALTH CARE SCIENCES & SERVICES Scandinavian Journal of Primary Health Care Pub Date : 2023-12-01 Epub Date: 2023-09-14 DOI:10.1080/02813432.2023.2255062

E Mellanen, T Kauppila, H Kautiainen, M Lehto, O Rahkonen, K Pitkälä, M K Laine

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Abstract

Objective: This study aimed to examine primary health care (PHC) service utilization and mortality in older patients with type 2 diabetes (T2D) with or without comorbidities.

Design and setting: A cohort study in PHC in the city of Vantaa, Finland. Follow-up period was set between the years 2011 and 2018.

Subjects: PHC patients aged 60 years or more with a T2D were included.

Main outcome measures: Service utilization was defined as the number of face-to-face appointments and telephone contacts between a patient and general practitioner (GP) or nurse. The presence of comorbidities was defined using the Charlson Comorbidity Index (CCI). Mortality was assessed using hazard ratio (HR) and standardized mortality ratio (SMR).

Results: In total, 11,020 patients were included and followed for 71,596 person years. Mean age of the women and men in the beginning of follow-up were 71 and 69 years, respectively. The patients in the study cohort had a mean of eight appointments per person year to the GPs or nurses. Patients with T2D with comorbidities had more appointments than patients with T2D without comorbidities (incidence rate ratio (IRR) 1.44 [95% CI 1.39-1.49]). Increase in the number of all appointments reduced mortality in patients with T2D with and without comorbidities. Between patients with T2D with comorbidities and patients with T2D without comorbidities, the age and sex adjusted HR for death was 1.50 (95% CI 1.39-1.62). The SMR was higher in patients with T2D with comorbidities (1.83 [95% CI 1.74-1.92]) than in patients with T2D without comorbidities (0.91 [95% CI 0.86-0.96]).

Conclusions: In older patients with T2D, the presence of comorbidities was associated with increased use of PHC services and increased mortality. Increase in the number of appointments was associated with reduced mortality in patients with T2D with or without comorbidities.Key PointsIn older patients with T2D, it has not been studied whether and to what extend multimorbidity affects use of PHC services and mortality.The presence of comorbidities according to the Charlson Comorbidity Index (CCI) was associated with increased use of PHC services.The number of appointments to GPs or nurses was associated with reduced mortality in patients with T2D with or without comorbidities according to the CCI.

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有或无合并症的老年2型糖尿病患者初级卫生保健服务的使用和死亡率

目的:本研究旨在探讨有或无合并症的老年2型糖尿病(T2D)患者的初级卫生保健(PHC)服务利用率和死亡率。设计与背景:芬兰万塔市PHC队列研究。随访期定在2011年至2018年之间。对象:60岁及以上伴有T2D的PHC患者。主要结果测量:服务利用被定义为患者与全科医生(GP)或护士面对面预约和电话联系的次数。使用Charlson共病指数(CCI)来定义合并症的存在。采用危险比(HR)和标准化死亡率(SMR)评估死亡率。结果:共纳入11,020例患者，随访71,596人年。随访开始时，女性和男性的平均年龄分别为71岁和69岁。研究队列中的患者平均每人每年有8次与全科医生或护士的预约。有合并症的T2D患者就诊次数多于无合并症的T2D患者(发病率比(IRR) 1.44 [95% CI 1.39-1.49])。所有预约次数的增加降低了有或无合并症的T2D患者的死亡率。有合并症的T2D患者与无合并症的T2D患者，经年龄和性别调整后的死亡风险比为1.50 (95% CI 1.39-1.62)。有合并症的T2D患者的SMR (1.83 [95% CI 1.74-1.92])高于无合并症的T2D患者(0.91 [95% CI 0.86-0.96])。结论:在老年T2D患者中，合并症的存在与PHC服务的使用增加和死亡率增加有关。就诊次数的增加与伴有或不伴有合并症的T2D患者死亡率的降低相关。在老年T2D患者中，尚未研究多重发病率是否以及在多大程度上影响初级保健服务的使用和死亡率。根据查理森合并症指数(CCI)，合并症的存在与初级保健服务的使用增加有关。根据CCI，预约全科医生或护士的数量与伴有或不伴有合并症的T2D患者死亡率降低相关。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Scandinavian Journal of Primary Health Care 医学-卫生保健

CiteScore

3.20

自引率

19.00%

发文量

审稿时长

>12 weeks

期刊介绍： Scandinavian Journal of Primary Health Care is an international online open access journal publishing articles with relevance to general practice and primary health care. Focusing on the continuous professional development in family medicine the journal addresses clinical, epidemiological and humanistic topics in relation to the daily clinical practice. Scandinavian Journal of Primary Health Care is owned by the members of the National Colleges of General Practice in the five Nordic countries through the Nordic Federation of General Practice (NFGP). The journal includes original research on topics related to general practice and family medicine, and publishes both quantitative and qualitative original research, editorials, discussion and analysis papers and reviews to facilitate continuing professional development in family medicine. The journal''s topics range broadly and include: • Clinical family medicine • Epidemiological research • Qualitative research • Health services research.