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Abstract：
BACKGROUND: In 2012, Luxembourg introduced a Referring Doctor (RD) policy, whereby patients voluntarily register with a primary care practitioner, who coordinates patients\' health care and ensures optimal follow-up. We contribute to the limited evidence base on patient registration by evaluating the effects of the RD policy.
METHODS: We used data on 16,775 people with type 2 diabetes on oral medication (PWT2D), enrolled with the Luxembourg National Fund from 2010 to 2018. We examined the utilisation of primary and specialist outpatient care, quality of care process indicators, and reimbursed prescribed medicines over the short- (until 2015) and medium-term (until 2018). We used propensity score matching to identify comparable groups of patients with and without an RD. We applied difference-in-differences methods that accounted for patients\' registration with an RD in different years.
RESULTS: There was low enrolment of PWT2D in the RD programme. The differences-in-differences parallel trends assumption was not met for: general practitioner (GP) consultations, GP home visits (medium-term), HbA1c test (short-term), complete cholesterol test (short-term), kidney function (urine) test (short-term), and the number of repeat prescribed cardiovascular system medicines (short-term). There was a statistically significant increase in the number of: HbA1c tests (medium-term: 0.09 (95% CI: 0.01 to 0.18)); kidney function (blood) tests in the short- (0.10 (95% CI: 0.01 to 0.19)) and medium-term (0.11 (95% CI: 0.03 to 0.20)); kidney function (urine) tests (medium-term: 0.06 (95% CI: 0.02 to 0.10)); repeat prescribed medicines in the short- (0.19 (95% CI: 0.03 to 0.36)) and medium-term (0.18 (95% CI: 0.02 to 0.34)); and repeat prescribed cardiovascular system medicines (medium-term: 0.08 (95% CI: 0.01 to 0.15)). Sensitivity analyses also revealed increases in kidney function (urine) tests (short-term: 0.07 (95% CI: 0.03 to 0.11)) and dental consultations (short-term: 0.06, 95% CI: 0.00 to 0.11), and decreases in specialist consultations (short-term: -0.28, 95% CI: -0.51 to -0.04; medium-term: -0.26, 95% CI: -0.49 to -0.03).
CONCLUSIONS: The RD programme had a limited effect on care quality indicators and reimbursed prescribed medicines for PWT2D. Future research should extend the analysis beyond this cohort and explore data linkage to include clinical outcomes and socio-economic characteristics.
METHODS: We used data on 16,775 people with type 2 diabetes on oral medication (PWT2D), enrolled with the Luxembourg National Fund from 2010 to 2018. We examined the utilisation of primary and specialist outpatient care, quality of care process indicators, and reimbursed prescribed medicines over the short- (until 2015) and medium-term (until 2018). We used propensity score matching to identify comparable groups of patients with and without an RD. We applied difference-in-differences methods that accounted for patients\' registration with an RD in different years.
RESULTS: There was low enrolment of PWT2D in the RD programme. The differences-in-differences parallel trends assumption was not met for: general practitioner (GP) consultations, GP home visits (medium-term), HbA1c test (short-term), complete cholesterol test (short-term), kidney function (urine) test (short-term), and the number of repeat prescribed cardiovascular system medicines (short-term). There was a statistically significant increase in the number of: HbA1c tests (medium-term: 0.09 (95% CI: 0.01 to 0.18)); kidney function (blood) tests in the short- (0.10 (95% CI: 0.01 to 0.19)) and medium-term (0.11 (95% CI: 0.03 to 0.20)); kidney function (urine) tests (medium-term: 0.06 (95% CI: 0.02 to 0.10)); repeat prescribed medicines in the short- (0.19 (95% CI: 0.03 to 0.36)) and medium-term (0.18 (95% CI: 0.02 to 0.34)); and repeat prescribed cardiovascular system medicines (medium-term: 0.08 (95% CI: 0.01 to 0.15)). Sensitivity analyses also revealed increases in kidney function (urine) tests (short-term: 0.07 (95% CI: 0.03 to 0.11)) and dental consultations (short-term: 0.06, 95% CI: 0.00 to 0.11), and decreases in specialist consultations (short-term: -0.28, 95% CI: -0.51 to -0.04; medium-term: -0.26, 95% CI: -0.49 to -0.03).
CONCLUSIONS: The RD programme had a limited effect on care quality indicators and reimbursed prescribed medicines for PWT2D. Future research should extend the analysis beyond this cohort and explore data linkage to include clinical outcomes and socio-economic characteristics.
摘要：
背景：2012年，卢森堡引入了参考医生（RD）政策，患者自愿向初级保健医生注册，协调患者的医疗保健并确保最佳随访。通过评估RD政策的效果，我们为基于患者注册的有限证据做出了贡献。
方法：我们使用了16,775名2型糖尿病患者的口服药物（PWT2D）数据，2010年至2018年加入卢森堡国家基金。我们检查了初级和专科门诊护理的利用率，护理过程质量指标，并在短期（至2015年）和中期（至2018年）报销处方药。我们使用倾向评分匹配来确定有和没有RD的患者的可比组。我们应用了差异差异方法，这些方法说明了患者在不同年份的RD注册。
结果：RD项目中PWT2D的入学率较低。不满足差异平行趋势假设：全科医生(GP)咨询，GP家访（中期），HbA1c测试（短期），完整的胆固醇测试（短期），肾功能（尿液）测试（短期），和重复处方心血管系统药物的数量（短期）。HbA1c测试的数量有统计学上的显着增加（中期：0.09（95％CI：0.01至0.18））；短期肾功能（血液）测试（0.10（95％CI：0.01至0.19））和中期（0.11（95％CI：0.03至0.20））；肾功能（尿液）测试（中期：0.06（95％CI：0.02至0.1％至0.1）：中程0.0.08（重复系统（95％CI）和敏感性分析还显示肾功能（尿液）检查（短期：0.07（95％CI：0.03至0.11））和牙科咨询（短期：0.06，95％CI：0.00至0.11）增加，专家咨询减少（短期：-0.28，95%CI：-0.51至-0.04；中期：-0.26，95%CI：-0.49至-0.03）。
结论：RD计划对PWT2D的护理质量指标和报销处方药的影响有限。未来的研究应将分析扩展到该队列之外，并探索数据链接以包括临床结果和社会经济特征。
方法：我们使用了16,775名2型糖尿病患者的口服药物（PWT2D）数据，2010年至2018年加入卢森堡国家基金。我们检查了初级和专科门诊护理的利用率，护理过程质量指标，并在短期（至2015年）和中期（至2018年）报销处方药。我们使用倾向评分匹配来确定有和没有RD的患者的可比组。我们应用了差异差异方法，这些方法说明了患者在不同年份的RD注册。
结果：RD项目中PWT2D的入学率较低。不满足差异平行趋势假设：全科医生(GP)咨询，GP家访（中期），HbA1c测试（短期），完整的胆固醇测试（短期），肾功能（尿液）测试（短期），和重复处方心血管系统药物的数量（短期）。HbA1c测试的数量有统计学上的显着增加（中期：0.09（95％CI：0.01至0.18））；短期肾功能（血液）测试（0.10（95％CI：0.01至0.19））和中期（0.11（95％CI：0.03至0.20））；肾功能（尿液）测试（中期：0.06（95％CI：0.02至0.1％至0.1）：中程0.0.08（重复系统（95％CI）和敏感性分析还显示肾功能（尿液）检查（短期：0.07（95％CI：0.03至0.11））和牙科咨询（短期：0.06，95％CI：0.00至0.11）增加，专家咨询减少（短期：-0.28，95%CI：-0.51至-0.04；中期：-0.26，95%CI：-0.49至-0.03）。
结论：RD计划对PWT2D的护理质量指标和报销处方药的影响有限。未来的研究应将分析扩展到该队列之外，并探索数据链接以包括临床结果和社会经济特征。
