Primary care and avoidable hospitalization for diabetes

1. Primary careandavoidablehospitalizationfor diabetes Michael van den Berg Tessa van Loenen (tessa.van.loenen@rivm.nl)

2. The QUALICOPC project General objective: To evaluate European primary care systems on quality, equity and costs Hypothesis:The way primary care is organized in a country is related to: • How patients perceive the quality of pc • How providers deliver services • Overall health care outcomes (quality, equity and costs)

3. The QUALICOPC project Three Surveys • Amongrandom samples of GPs(around 220/country) • Amongpatientsvisiting GP practices(10/practice) • Among the field workersvisiting GP practices(1/practice) More information on: www.qualicopc.eu

4. Workpackage: Avoidable hospital admissions • Admission rates for ambulatory care sensitive conditions (ACSC) • Indicator for primary health care performance, quality and access • Which admissions can be avoided? • Acute conditions • Adverse drugs events • Chronic conditions  Diabetes • Objective: • Gain insight in relationships at country level between the structure and organization of primary care and the prevalence of avoidable hospitalizations for Diabetes

5. Avoidable hospitalization: Source: OECD Health data 2011

6. Avoidable hospitalization:

7. Avoidable hospital admissions and Primary care • 3 Primary care organizational characteristics: • Access • Financial or geographical access, ooh-care, waiting times • Position primary care in health care system • Central or marginal role, medical record keeping, referrals, continuity • Task profile • Broad or small task profiles Hypothesis: Systems with easily accessible, central primary care with broad task profile have lower prevalence of avoidable hospitalization

8. Methods Data sources: • QUALICOPC data: GP questionnaire and Patient questionnaire • OECD Health care quality indicators Analyses: • Analyses are based on 22 countries • Ecometricsfor scale construction at country level • Simple regressions • multivariable regression with one control variable: Diabetes prevalence

9. Results: Taskprofile * p-value <0.1 ** p-value <0.05

10. Results: Taskprofile

11. Results: Access * p-value <0.1 ** p-value <0.05

12. Results: Access

13. Results: Position of PC

14. Discussion • Based on these preliminary data: • Differences between countries can partly be explained by organization and structural differences • Diabetes prevalence : what other factors to take into account? • Future steps: Include more countries • Update OECD data on avoidable hospitalization • Include more QUALICOPC countries

16. Source: IDF 2012

17. Results: Position of PC