目的:我们在这项研究中的目的是确定社区水平的医生保留对安大略省农村地区糖尿病护理质量的影响。
方法:使用管理数据,我们比较了糖尿病的护理质量。我们将保留率定义为从一年到下一年的社区中医生的比例。我们对保留率水平进行了分组,并为没有医生的社区添加了一个类别。
结果:高保留社区的居民更有可能患有糖化血红蛋白(优势比[OR],1.10;95%置信区间[CI],1.06至1.14)和低密度脂蛋白(OR,1.17;95%CI,1.13至1.22)测试,但不太可能进行尿白蛋白与肌酸比率检测(OR,0.86;95%CI,0.83至0.89)或接受过血管紧张素转换酶抑制剂或血管紧张素2受体阻滞剂(OR,0.91;95%CI,0.86至0.95)或他汀类药物(OR,0.91;95%CI,0.87至0.96),与低保留社区相比。没有住院医生的社区的护理与高保留率社区的护理相当或更好。
结论:社区级医师保留率,根据两年的时间框架,与糖尿病护理质量显著相关。有必要仔细研究没有住院医生的社区的护理模式。社区级别的医生保留率可用于评估医生短缺对农村社区糖尿病管理的影响。
OBJECTIVE: Our aim in this study was to determine the impact of community-level physician retention on the quality of diabetes care in rural Ontario.
METHODS: Using administrative data, we compared diabetes quality of care. We defined retention as the proportion of physicians in a community from one year to the next. We grouped retention level by tertile and added a category for those communities with no physician.
RESULTS: Residents of high-retention communities were more likely to have had glycated hemoglobin (odds ratio [OR], 1.10; 95% confidence interval [CI], 1.06 to 1.14) and low-density lipoprotein (OR, 1.17; 95% CI, 1.13 to 1.22) testing, but less likely to have had testing for urine albumin-to-creatine ratio (OR, 0.86; 95% CI, 0.83 to 0.89) or to have received an angiotensin-converting enzyme inhibitor or angiotensin-2 receptor blocker (OR, 0.91; 95% CI, 0.86 to 0.95) or a statin (OR, 0.91; 95% CI, 0.87 to 0.96), when compared with low-retention communities. Communities with no residing physician had care that was equivalent to or better than that in high-retention communities.
CONCLUSIONS: Community-level physician retention, based on a 2-year time frame, was significantly related to quality of diabetes care. A closer look at models of care in communities with no residing physician is warranted. Community-level physician retention can be used to assess the impact of physician shortages on diabetes management in rural communities.