Primary care service utilisation and outcomes in type 2 diabetes: A longitudinal cohort analysis

Problem

It is unclear what relationship, if any, exists between service utilisation and clinical outcomes in patients with type 2 diabets. Trends in primary care utilisation in this group over time are also unknown.

Approach

Using routine data from the Electronic Care and Health Information Analytics (CHIA) database, we performed a retrospective cohort study in 110,240 adults with type 2 diabetes in the South of England between 2013 and 2020. Utilisation patterns over time were summarised using descriptive statistics. Maximally adjusted multivariable logistic regression models were used to examine associations between service utilisation, defined as total number of primary care contacts, cardiovascular events, and all-cause mortality.

Findings

Between 2013 and 2020 mean number of primary care attendances pre year quarter rose from a mean (standard deviation) of 2.48 (2.01) to 2.78 (2.06). After adjusting for potential confounders, we observed an association between higher rates of service utilisation and higher rates of cardiovascular events (odds ratio (OR) per additional consultation 1.0058; 95% confidence intervals 1.0053 - 1.0062; p<0.001) and mortality (OR 1.0057; 95%CI 1.0051 - 1.0064; p<0.001).

Consequences

Between 2013 and 2020 primary care usage increased 12% among people with type 2 diabetes. As opposed to achieving better disease control and developing fewer complications, patients with more frequent primary care contacts had higher HbA1c, higher rates of CVD, and higher rates of mortality. Although these patients tended to be older and more multimorbid, these associations persisted after adjustment for these and other confounders. Further research capturing the nature, content and duration of contacts in relation to delivery of care for type 2 diabetes is needed to understand the mechanisms underlying this association and address contributory factors.