Effect of a general practitioner management plan on health outcomes and hospitalisations in older patients with diabetes

Abstract

Background: Little is known about the impact of a general practitioner management plan (GPMP) on health outcomes of patients with diabetes. Aim: To examine the impact of a GPMP on risk of hospitalisation for diabetes. Methods: A retrospective study using administrative data from the Australian Government Department of Veterans' Affairs was conducted (1st July 2006 to 30th June 2014) of diabetes patients either exposed or unexposed to a GPMP. Primary endpoint was risk of first hospitalisation for a diabetes-related complication and was assessed with Cox proportional hazard regression models with death as a competing risk. Secondary endpoints included rates of receiving guideline care for diabetes with differences assessed using Poisson regression analyses. Results: A total of 16,214 patients with diabetes were included; 8091 had a GPMP and 8123 did not. After one year, 545 (6.7%) patients with a GPMP and 634 (7.8%) of patients without a GPMP were hospitalised for a diabetes complication. There was a 22% reduction in the risk being hospitalised for a diabetes complication (adjusted HR 0.78, 95% CI 0.69-0.87, p < 0.0001) for those who received a GPMP by comparison to those who did not. Increased rates of diabetes guideline-care, HbA1c claims (adjusted HR 1.29, 95% CI 1.25-1.33) and microalbuminura claims (adjusted HR 1.65, 95% CI 1.58-1.72) were observed after a GPMP. Conclusions: Provision of a GPMP in older patients with diabetes resulted in improved health outcomes, delaying risk of hospitalisation at 12 months for diabetes-complications. GPMPs should be included as part of routine primary care for older patients with diabetes.