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J Eval Clin Pract. 2010 Oct;16(5):887-94. doi: 10.1111/j.1365-2753.2009.01208.x.

Does systematically organized care improve outcomes for women with diabetes?

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1
Research Centre for Gender, Health and Ageing, University of Newcastle, Newcastle, NSW, Australia. julia.lowe@sunnybrook.ca

Abstract

OBJECTIVE:

To investigate whether financial reimbursement for a bundle of diabetes care items self-reported by general practitioners (GPs) leads to improved outcomes for women with diabetes.

METHODS:

Longitudinal cohort study of women in the Australian Longitudinal Study on Women's Health aged 45-50 and 70-75 years when recruited in 1996.

OUTCOMES:

Short Form 36-item (SF-36), Medicare and pharmaceutical benefits costs 2002-2005, uptake of annual cycle of care for diabetes (ACC).

RESULTS:

Annual cycle of care claims were identified for 23% of 388 mid-age, and 40% of 616 older women with diabetes. ACC was not associated with statistically significantly higher costs in either group. Women for whom the GP had received an ACC fee were more likely to have been overweight, had more GP visits, more medications, and more 'no cost' visits. Unlike older women, mid-age women for whom the GP had received an ACC fee were more likely to have difficulty managing on their income and tended to have worse physical and social function scores prior to the time the ACC was introduced and compared with other women with diabetes continued to have poorer scores at subsequent surveys. There was no association between ACC, co-morbidities or country of birth. Women who developed diabetes after the first survey (incident cases) tended to have better SF-36 health profile scores and lower costs than those who reported diabetes on the first survey (prevalent cases).

CONCLUSIONS:

General practitioners of women with diabetes, who have more health care encounters and poorer health-related quality of life, have adopted ACC with little impact on the decline in quality of life of the women nor on health care costs.

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