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Table 2 Diabetes-related hospital outcome measures and primary health care resource inputs and direction of significant study findings

From: A systematic review of evidence on the association between hospitalisation for chronic disease related ambulatory care sensitive conditions and primary health care resourcing

First author, date published (country) Hospital outcome measure Primary health care resource inputs and direction of significant study findings
Category of diabetes-related ACSC (reporting of results) Description of how measured (level of variable) PHC resources significantly associated with an increase [↑] or decrease [↓] in hospitalisationa
(level of variable)
PHC variables that were not significant i.e. p value >0.05, or reference measure (level of variable)
Dusheiko 2011 (England) Emergency (unplanned) hospitalisations due to (all) short-term diabetic complicationsb (incidence rate) Incidence rate per family practice (health centre) (f) Nil Population per FTE family physician (f)
Griffiths 2010 (England) Non-elective diabetes-related hospitalisations (rate per facility) Rate per number of patients on the register experiencing ≥ 1 hospitalisation (f) Increase in the number of patients per FTE GP(f) [↓]c <3038 patients per FTE practice nurse (f) [↑] 3039–3901 patients per FTE practice nurse (f) [↑] 4823–6210 patients per FTE practice nurse (f) [↓] 6210+ patients per FTE practice nurse (f) [↓] Sole practitioner practice (f) Primary medical service contract (f) 3901–4823 patients per FTE practice nurse i.e. Quintile 3 (f)
   Rate per number of patients on the register experiencing ≥ 2 hospitalisation (f) Number of patients per FTE GP (f) [↓] <3038 patients per FTE practice nurse (f) [↑] 3901–4823 patients per FTE practice nurse (f) [↑] Sole practitioner practice (f) Primary medical service contract (f) 3039–3901 patients per FTE practice nurse i.e. Quintile 2 (f) 4823–6210 patients per FTE practice nurse (f) i.e. Quintile 4 6210+ patients per FTE practice nurse (f) i.e. Quintile 5
Lavoie 2010 (Canada) Chronic ACSC hospitalisation (rate difference) Average difference in rates of hospitalisation between level of primary care serviced (f) Health centre versus no facility (f) [↓] Health office versus no facility (f) [↓] Health centre versus nursing station (f) [↑] Health office versus nursing station (f) [↑] Nursing station and no facility (f)
Ng 2010 (Canada) An acute hospitalisation for any reason among persons age 12 years or older with type 2 diabetes (odds ratio) Status of hospitalisation (yes or no) (i) An increase in self-reported number of GP contacts in the previous 12 months [↓] Nil
Bruni 2009 (Italy) Hyperglycemic emergency hospitalisations (probability of being hospitalised) Hospitalised, yes or no (i) As number of visits to diabetes outreach clinic increased (i) [↑] More patients per gp 1100–1500 and >1500 (iGP) [↑] Larger proportion of annual income from pay-for-participation (GP payments related to number of patients with diabetes) (iGP) [↓] Health district receives ≥75 % GP income from incentive schemes (d) [↓] Patients per GP <1100 (ref) Practice type, i.e. sole practitioner (ref), association, network, group (iGP) Per cent diabetic patients (iGP) Per cent annual income pay-for-compliance (GP payments related to the number of quality improvement processes involved in e.g. diabetes audit) (iGP) Health district receives 25–75 % GP income from incentives schemes (d)
El-Din 2009 (Saudi Arabia) Type 2 diabetes related hospitalisation (odds of being hospitalised) Hospitalised, yes or no (i) ≥ 6 outpatient PHC clinic visits, except diabetes clinic (i) [↑] No outpatient clinic visits (ref) (i) 1–5 outpatient clinic visits (i)
Lin 2009 (Taiwan) Short-term diabetes ACSC and long-term ACSC modelled separately (relative risk ratio) Status of hospitalisation (yes or no) (i) More outpatient diabetes visits per year (i) [↑] Diabetes management received (primary care clinic (ref), medical centre, regional or district hospitals (i)
Rizza 2007 (Italy) Hospitalisation for diabetes ambulatory care sensitive conditions (odds ratio) Status of hospitalisation (yes or no) (i) As the number of patients per primary care physician increases (iGP) [↑] Number of primary care physician visits in previous year (i) Number of specialist visits in community health services (f)
Gulliford 2004e (England) Hospitalisation for chronic conditions (chronic hospital admissions per 100 000 persons) Rate of hospitalisation per 100 000 persons (ha)f As GP supply increases per 10 000 weighted population (ha) [↓] As mean partnership size increases (ha) [↓] As proportion of sole provider practices increase (ha) [↑] Per cent practices with diabetes service (ha)
Gulliford 2002e (England) Hospitalisation for chronic conditions (chronic hospital admissions per 100 000 persons) Rate of hospitalisation per 100 000 persons (ha) As GP supply increases per 10 000 persons (ha) [↓] Nil
  1. Notes:
  2. a Tested for inclusion in the final model with level of significance ≤ 0.05.
  3. b Authors also used acute, non-specific hyperglycemia, and hypoglycaemia as individual dependent variables (the all short-term diabetes complications shown in this table was the sum of each of these and the primary care resource variable is not statistically significant in any of the models).
  4. c Example of interpretation: the non-elective diabetes-related hospitalisation rate per facility decreases with an increase in the number of patients per GP; more patients per GP translate to less primary health care resources per capita.
  5. d Level of service includes: health office = part-time service, health centre = working hours limited and no after-hours care, nursing station = 24/7 care (including emergency).
  6. e Same data source.
  7. f Adjusted for confounders; deprivation score, proportion in semi or unskilled social class, proportion households with ethnic minority residents.
  8. (i) individual level variable, (f) facility level variable, (d) district area level variable, (ha) health authority level variable, (iGP) individual GP level variable, [↑] result showed the PHC resource of interest increased hospitalisation, [↓] result showed the PHC resource of interest decreased hospitalisation, ns – Not significant, (ref) – Reference measure, PHC – Primary health care, GP – General practitioner, FTE – Full-time equivalent, UK – United Kingdom.