A case-matched study of who is referred for specialist diabetes care
✍ Scribed by Overland, J ;Yue, DK ;Simpson, JM
- Publisher
- John Wiley and Sons
- Year
- 1998
- Tongue
- English
- Weight
- 378 KB
- Volume
- 15
- Category
- Article
- ISSN
- 1357-8170
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✦ Synopsis
Abstract
To establish the clinical profile of patients with diabetes cared for exclusively by their general practitioner and to identify factors associated with referral to specialist care, 58 patients cared for exclusively by their general practitioner were case‐matched with the last patient referred by the same general practitioner to specialist care at the Diabetes Centre, Royal Prince Alfred Hospital in Sydney, Australia. The glycaemic exposure and complication status were similar in the two groups. Patients requiring insulin (OR: 15.5, 95% Cl: 3.2 to 73.9, p=0.0006) and those with absent ankle reflexes (OR: 4.8, 95% Cl: 1.4 to 16.9, p=0.013) were much more likely to be referred for assessment at the specialist level. They also had lower systolic blood pressure (OR: 0.96, 95% CI: 0.94 to 0.99, p=0.0046) when compared with those patients cared for by the general practitioner alone. Our findings indicate that, for GPs who refer some patients to the Centre, patients cared for at the community level do not have better diabetes control than those referred for specialist care. The reliance on insulin treatment as an indicator of referral is by itself insufficient. Persistently poor metabolic control, the presence of complications and a long duration of diabetes are additional referral prompts to ensure patients receive the right level of care.