Objective Management of type 2 diabetes mellitus (T2DM) requires frequent patient monitoring. Within a collective care group setting, doubts on the clinical effects of registration are a barrier... Show more Objective Management of type 2 diabetes mellitus (T2DM) requires frequent patient monitoring. Within a collective care group setting, doubts on the clinical effects of registration are a barrier for full adoption of T2DM registration in general practice. We explored whether full monitoring of physiological, biomedical and lifestyle-related target indicators within a care group approach is associated with lower HbA1c levels. Design Observational, real-life cohort study Setting Primary care data registry from the EerstelijnsZorggroepHaaglanden care group. Exposure The care group provides general practitioners collectively with organisational support to facilitate structured T2DM primary care. Patients are offered quarterly medical and lifestyle-related consultation. Main outcome measure Full monitoring of each target indicator in patients with T2DM, which includes minimally one measure of HbA1c level, systolic blood pressure, LDL, BMI, smoking behaviour and physical exercise between January and December 2014; otherwise, patients were defined as ´incompletely monitored´. HbA1c levels of 8,137 fully-monitored and 3,958 incompletely-monitored patients were compared, adjusted for the confounders diabetes duration, age and gender. Since recommended HbA1c values depend on age, medication use and diabetes duration, analyses were stratified into three HbA1c profile groups. Linear multilevel analyses enabled adjustment for general practice. Results Compared to incompletely-monitored patients, fully-monitored patients had significantly lower HbA1c levels [95%CI] in the first (-2.03 [-2.53;-1.52]mmol/mol) (-0.19% [-0.23%;-0.14%]), second (-3.36 [-5.28;-1.43]mmol/mol) (-0.31% [-0.48%;-0.13%]) and third HbA1c profile group (-1.89 [-3.76;-0.01]mmol/mol) (-0.17% [-0.34%;0.00%]). Conclusions/interpretation This study shows that in a care group setting, fully-monitored patients had significantly lower HbA1c levels compared with incompletely-monitored patients. Since this difference might have considerable clinical impact in terms of T2DM-related risks, this might help general practices in care group settings to overcome barriers on adequate registration and thus improve structured T2DM primary care. From population health management perspective, we recommend a systematic approach to adjust the structured care protocol for incompletely-monitored subgroups. Show less
The management of care of chronic obstructive pulmonary disease improved over the last years but is still very complex. Both over- and underdiagnosis are often reported and misclassification of... Show moreThe management of care of chronic obstructive pulmonary disease improved over the last years but is still very complex. Both over- and underdiagnosis are often reported and misclassification of disease severity is common. Differentiating between chronic obstructive pulmonary disease, asthma and asthma-chronic obstructive pulmonary disease overlap syndrome remains difficult. Much is known about the effectiveness of treatment approaches in chronic obstructive pulmonary disease, but patients are often not treated according to the guidelines, and we need more evidence on effectiveness in phenotypes of chronic obstructive pulmonary disease. Care coordination is of great importance and can help to further improve care for chronic obstructive pulmonary disease patients. Pulmonary rehabilitation and self-management are considered important aspects of chronic obstructive pulmonary disease care. In our opinion, there is a major role for eHealth to improve coordination of care of chronic obstructive pulmonary disease. Show less
