Population, general practitioner and practice characteristics are associated with screening procedures for microvascular complications in Type 2 diabetes care in Norway. Issue 11 (27th November 2018)

• Record Type: Journal Article
• Authors: Bakke, Å.; Tran, A. T.; Dalen, I.; Cooper, J. G.; Løvaas, K. F.; Jenum, A. K.; Berg, T. J.; Madsen, T. V.; Nøkleby, K.; Gjelsvik, B.; Claudi, T.; Skeie, S.; Carlsen, S.; Sandberg, S.; Thue, G.
• Is Part Of: Diabetic medicine. Volume 36:Issue 11(2019)
• Page Start: 1431
• Page End: 1443
• Publication Date: 2018-11-27
• Subjects: Diabetes -- Periodicals; 616.462
• DOI: 10.1111/dme.13842
• Languages: English
• ISSNs: 0742-3071

Abstract

Abstract: Aims: To assess population, general practitioner (GP) and practice characteristics associated with the performance of microvascular screening procedures and to propose strategies to improve Type 2 diabetes care. Methods: A cross‐sectional survey in Norway (281 GPs from 77 practices) identified 8246 people with a Type 2 diabetes duration of 1 year or more. We used multilevel regression models with either the recording of at least two of three recommended screening procedures (albuminuria, monofilament, eye examination) or each procedure separately as dependent variable (yes/no), and characteristics related to the person with diabetes, GP or practice as independent variables. Results: The performance of recommended screening procedures was recorded in the following percentages: albuminuria 31.5%, monofilament 27.5% and eye examination 60.0%. There was substantial heterogeneity between practices, and between GPs within practices for all procedures. Compared with people aged 60–69 years, those aged < 50 years were less likely to have an albuminuria test performed [odds ratio (OR) 0.75, 95% CI 0.61 to 0.93] and eye examination (OR 0.79, 95% CI 0.66 to 0.95). People with macrovascular disease had fewer screening procedures recorded (OR 0.68, 95% CI 0.59 to 0.78). Use of an electronic diabetes form was associated with improved screening (OR 2.65, 95% CI 1.86 to 3.78). GPs with high workload recorded fewer procedures (OR 0.59, 95% CI 0.39 to 0.90). Conclusions: Performance of screening procedures was suboptimal overall, and in people who should be prioritized. Performance varied substantially between GPs and practices. The use of a structured diabetes form should be mandatory. What's new?: We found major gaps in microvascular complication screening in Norwegian general practice among people with Type 2 diabetes. Screening procedures for microvascular complications were associated with population, general practitioner (GP) and practice characteristics. People with short diabetes duration and with no oral anti‐hyperglycaemic therapy were rarely screened for complications. Younger people (aged < 50 years), and people with macrovascular disease were less likely to have screening procedures performed. GP use of a structured diabetes form was associated with higher recordings of microvascular screening procedures. Practices with routines for annual diabetes review were more likely to record screening procedures.