the impact of adherence to screening guidelines and of diabetes clinics referral on morbidity and mortality in diabetes坚持检查指导方针的影响和糖尿病诊所推荐在糖尿病的发病率和死亡率.pdfVIP

The Impact of Adherence to Screening Guidelines and of Diabetes Clinics Referral on Morbidity and Mortality in Diabetes 1 2 3 3 1 2,4 Carlo Giorda *, Roberta Picariello , Elisa Nada , Barbara Tartaglino , Lisa Marafetti , Giuseppe Costa , Roberto Gnavi2 1 Metabolism and Diabetes Unit, ASL TO5, Regione Piemonte, Chieri, Italy, 2 Epidemiology Unit, ASL TO3, Regione Piemonte, Grugliasco, Italy, 3 Chaira Medica Association, Chieri, Italy, 4 Department of Public Health, University of Torino, Torino, Italy Abstract 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