Background There is international consensus that optimal management of uncomplicated diabetes involves structured multidisciplinary management in primary care with specialist input when required. In Ireland care arrangements for people with diabetes range from traditional specialist care to structured GP-led management. In an effort to standardise the service, a national model of integrated care has been proposed. Our aim was to estimate current primary, secondary and ancillary health service use (HSU) among older people with diabetes.
Methods Cross-sectional analysis of a population-based sample of adults aged ≥50 years who participated in wave 1 of TILDA (2009–2011). Diabetes was based on self-reported doctor diagnosis. Self-reported HSU in the previous 12 months included the attendance and number of GP visits, out-patient department visits (OPD), and attendance at ancillary services (dietician, chiropodist or optician). Multivariate negative binomial regression was used to estimate the association between diabetes and frequency of visits, adjusted for age, sex, locality, education, health insurance, complications, presence of other chronic illness, and insulin use.
Results Among 8175 participants, diabetes was reported by 634 individuals (weighted prevalence 8.1% [95% CI: 7.5% –8.8%]). Participants with diabetes were older (mean age 66.6 years vs. 63.5 years) and a higher proportion were male (57.3% vs. 47.2%).
Most people with diabetes attended the GP in the previous 12 months (n = 604, 95.7% [95% CI: 94–97%]); 61% of those also attended the OPD (n = 367, [95% CI: 57%–65%]). Among healthcare users, the median (IQR) number of visits per annum was higher in those with diabetes compared to the general population (GP visits: 4 [3–7.5] vs. 3 [2–5]; p ≤ 0.001; OPD visits: 4 [3–9] vs. 4 [3–9]; p ≤ 0.001). A much higher proportion of those with diabetes accessed ancillary state services compared to the general population (dietician 11.3% [95% CI: 8.9%–14.2%] v 0.6% [95% CI: 0.5%–0.8%]; chiropody: 15.7% [95% CI: 12.9%–18.8%] v 3.8% [95% CI: 3.3%–4.4%]; optician: 20.5% [95% CI: 17.4%–24.1%] v 11.5% [95% CI: 10.4%–12.4%]; p ≤ 0.001).
In fully adjusted model, diabetes was independently associated with more frequent use of GP services (IRR 1.3 [95% CI 1.2–1.4] p ≤ 0.001) and OPD services (IRR 1.3 [95% CI: 1.1–1.6] p ≤ 0.001).
Discussion Among older people in Ireland, diabetes is associated with increased frequency of GP and OPD visits, independent of diabetes-related complications. Less than 25% of those with diabetes attended state-provided dietetic and chiropody services; this may reflect the use of private services in the face of limited public access.
- health service utilisation
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