The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.

Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and organizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is scanty. We identified diabetic residents in Torino, Italy, as of...

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Autores principales:	Carlo Giorda, Roberta Picariello, Elisa Nada, Barbara Tartaglino, Lisa Marafetti, Giuseppe Costa, Roberto Gnavi
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2012
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/163eea4888a74592ba7f05dae449349e
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spelling	oai:doaj.org-article:163eea4888a74592ba7f05dae449349e2021-11-18T07:23:25ZThe impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.1932-620310.1371/journal.pone.0033839https://doaj.org/article/163eea4888a74592ba7f05dae449349e2012-01-01T00:00:00Zhttps://www.ncbi.nlm.nih.gov/pmc/articles/pmid/22509263/?tool=EBIhttps://doaj.org/toc/1932-6203Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and organizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is scanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care management of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI). Then, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity over a 4 year-follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no fulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57-1.89]), cardiovascular (1.74 [95% CI 1.50-2.01]) and cancer (1.35 [95% CI 1.14-1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs for incidence of major cardiovascular events up to 2.03 (95% CI 1.26-3.28) for lower extremity amputations. Receiving specialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout the whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that management of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable impact on all-cause mortality and CV incidence, provided that guidelines are implemented.Carlo GiordaRoberta PicarielloElisa NadaBarbara TartaglinoLisa MarafettiGiuseppe CostaRoberto GnaviPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 7, Iss 4, p e33839 (2012)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Carlo Giorda Roberta Picariello Elisa Nada Barbara Tartaglino Lisa Marafetti Giuseppe Costa Roberto Gnavi The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
description	Despite the heightened awareness of diabetes as a major health problem, evidence on the impact of assistance and organizational factors, as well as of adherence to recommended care guidelines, on morbidity and mortality in diabetes is scanty. We identified diabetic residents in Torino, Italy, as of 1st January 2002, using multiple independent data sources. We collected data on several laboratory tests and specialist medical examinations to compare primary versus specialty care management of diabetes and the fulfillment of a quality-of-care indicator based on existing screening guidelines (GCI). Then, we performed regression analyses to identify associations of these factors with mortality and cardiovascular morbidity over a 4 year-follow-up. Patients with the lowest degree of quality of care (i.e. only cared for by primary care and with no fulfillment of GCI) had worse RRs for all-cause (1.72 [95% CI 1.57-1.89]), cardiovascular (1.74 [95% CI 1.50-2.01]) and cancer (1.35 [95% CI 1.14-1.61]) mortality, compared with those with the highest quality of care. They also showed increased RRs for incidence of major cardiovascular events up to 2.03 (95% CI 1.26-3.28) for lower extremity amputations. Receiving specialist care itself increased survival, but was far more effective when combined with the fulfillment of GCI. Throughout the whole set of analysis, implementation of guidelines emerged as a strong modifier of prognosis. We conclude that management of diabetic patients with a pathway based on both primary and specialist care is associated with a favorable impact on all-cause mortality and CV incidence, provided that guidelines are implemented.
format	article
author	Carlo Giorda Roberta Picariello Elisa Nada Barbara Tartaglino Lisa Marafetti Giuseppe Costa Roberto Gnavi
author_facet	Carlo Giorda Roberta Picariello Elisa Nada Barbara Tartaglino Lisa Marafetti Giuseppe Costa Roberto Gnavi
author_sort	Carlo Giorda
title	The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
title_short	The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
title_full	The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
title_fullStr	The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
title_full_unstemmed	The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
title_sort	impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.
publisher	Public Library of Science (PLoS)
publishDate	2012
url	https://doaj.org/article/163eea4888a74592ba7f05dae449349e
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The impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes.

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