Abstract
BACKGROUND: Family doctor service (FDS) is a scheme oriented to improving the access and continuity of primary care in China. Type 2 diabetes mellitus (T2DM) management is a core component of FDS. However, evidence on the quality of T2DM care is lacking and the potential association between FDS attributes and T2DM care is largely unknown. This study attempted to assess the process quality of T2DM care in general practice and explore the association between patient perceived FDS attributes and process quality of T2DM care. METHODS: Total 400 patients were recruited from 5 community health service centers in two urban districts in Beijing. Questionnaire survey and extraction of data from electronic health record (EHR) were conducted to collect patient characteristics, patient perceived FDS attributes (accessibility, continuity and team-based care) and process quality indicators (monitoring and health counseling indicators). Chi-square test and a two-level generalized linear mixed model (GLMM) were used to explore the association between FDS attributes and process quality. RESULTS: The utilization rate of all the 12 indicators in monitoring, 6 indicators in health counseling and all the 18 process indicators, was 12.8%, 23.8% and 6.0% respectively. Over half of the patients (56.8%) perceived all the 3 FDS attributes. There were statistically significant associations between accessibility of care and lipid (p = 0.008), electrocardiogram (p = 0.016), retinopathy (p = 0.037) and peripheral neuropathy (p = 0.006) monitoring and each of the 6 health counseling indicators (all the p values < 0.05). Regular follow up (p = 0.039), plasma blood glucose (p = 0.020), blood pressure (p = 0.026), body mass index (p = 0.044) and foot (p = 0.005) monitoring as well as each of the 6 health counseling indicators (all the p values < 0.05) were more likely to be received by patients when continuity of care was ensured. Patients who were managed by a GP team had higher utilization rate of glycosylated hemoglobin monitoring (p = 0.026) and each of the 6 health counseling indicators (all the p values < 0.05). When the patients perceived one more FDS attribute, the indicators they received significantly increased by 1.50 (coefficient = 1.50, p < 0.001). Patients between the age of 65 and 74 years received 1.15 more indicators than those under 65 (coefficient = 1.15, p = 0.003). Patients with more than ten years duration of T2DM received 0.74 more indicators (coefficient = 0.74, p = 0.028). Patients taking both insulin and oral medicine received 0.97 more indicators than those taking oral medication only (coefficient = 0.97, p = 0.027). Patients who were managed by GPs with on-job training experience received 1.19 more indicators (coefficient = 1.19, p = 0.040). Among the patients who had completed junior high school or below, having better self-report health status (≥ 60) received 2.40 less indicators (coefficient = -2.40, p = 0.004). CONCLUSIONS: Improvement of key monitoring and health counseling indicators might be needed in T2DM care in general practice in Beijing, China. Policies for improving process quality of T2DM care should be considered.