| Title |
Clinic and patient variation in intermediate clinical outcomes for type 2 diabetes: a multilevel analysis
|
|---|---|
| Published in |
BMC Primary Care, November 2019
|
| DOI | 10.1186/s12875-019-1045-1 |
| Pubmed ID | |
| Authors |
Yvonne Mei Fong Lim, Swee Hung Ang, Nazrila Hairizan Nasir, Fatanah Ismail, Siti Aminah Ismail, Sheamini Sivasampu |
| Abstract |
Variation at different levels of diabetes care has not yet been quantified for low- and middle-income countries. Understanding this variation and its magnitude is important to guide policy makers in designing effective interventions. This study aims to quantify the variation in the control of glycated haemoglobin (HbA1c), systolic blood pressure (SBP) and low-density lipoprotein cholesterol (LDL-C) for type 2 diabetes (T2D) patients at the clinic and patient level and determine patient and clinic factors associated with control of these outcomes in T2D. This is a cross-sectional study within the baseline data from the impact evaluation of the Enhanced Primary Health Care (EnPHC) intervention on 40 public clinics in Malaysia. Patients aged 30 and above, diagnosed with T2D, had a clinic visit for T2D between 01 Nov 2016 and 30 April 2017 and had at least one HbA1c, SBP and LDL-C measurement within 1 year from the date of visit were included for analysis. Multilevel linear regression adjusting for patient and clinic characteristics was used to quantify variation at the clinic and patient levels for each outcome. Variation in intermediate clinical outcomes in T2D lies predominantly (93% and above) at the patient level. The strongest predictors for poor disease control in T2D were the proxy measures for disease severity including duration of diabetes, presence of microvascular complications, being on insulin therapy and number of antihypertensives. Among the three outcomes, HbA1c and LDL-C results provide greatest opportunity for improvement. Clinic variation in HbA1c, SBP and LDL-C accounts for a small percentage from total variation. Findings from this study suggest that standardised interventions need to be applied across all clinics, with a focus on customizing therapy based on individual patient characteristics. |
X Demographics
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Geographical breakdown
| Country | Count | As % |
|---|---|---|
| United States | 1 | 100% |
Demographic breakdown
| Type | Count | As % |
|---|---|---|
| Practitioners (doctors, other healthcare professionals) | 1 | 100% |
Mendeley readers
The data shown below were compiled from readership statistics for 38 Mendeley readers of this research output. Click here to see the associated Mendeley record.
Geographical breakdown
| Country | Count | As % |
|---|---|---|
| Unknown | 38 | 100% |
Demographic breakdown
| Readers by professional status | Count | As % |
|---|---|---|
| Student > Bachelor | 10 | 26% |
| Student > Master | 5 | 13% |
| Student > Ph. D. Student | 3 | 8% |
| Researcher | 2 | 5% |
| Other | 2 | 5% |
| Other | 2 | 5% |
| Unknown | 14 | 37% |
| Readers by discipline | Count | As % |
|---|---|---|
| Medicine and Dentistry | 12 | 32% |
| Nursing and Health Professions | 5 | 13% |
| Biochemistry, Genetics and Molecular Biology | 2 | 5% |
| Pharmacology, Toxicology and Pharmaceutical Science | 1 | 3% |
| Unspecified | 1 | 3% |
| Other | 4 | 11% |
| Unknown | 13 | 34% |
Attention Score in Context
This research output has an Altmetric Attention Score of 1. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 November 2019.
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#20,667,544
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Outputs from BMC Primary Care
#1,955
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Outputs of similar age
#284,508
of 373,472 outputs
Outputs of similar age from BMC Primary Care
#35
of 46 outputs
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