diabetic retention in the national ‘get checked’ programme dr rawiri keenan janet amey prof....
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Diabetic Retention in the National ‘Get Checked’ Programme
Dr Rawiri Keenan
Janet Amey
Prof. Ross Lawrenson
MHN
• Tairawhiti, Taupo, Waikato, Peak & Hauora
• 102 general practice teams
• 17,500 coded diabetics in 2009/10
Methods
• Data held by MHN/MoH• DARs 06/07, had a further 2 in 3 years• Excluded Type 1 diabetes• Excluded if death or migrated
95 Practices with data from 2006/07 year
17 excluded (data reliability, practice closed, merged or left MHN)
Excluded people with type 1 diabetes
78 practices with 6,875 patients with diabetes included overall in analysis
The Questions
• Relationship between QP vs retention?
• Just the patient?
• Just the practice?
• What happens all together?
Patient Characteristics
SexNumber of Patients having at least
1 Review
F 3455
M 3418
Missing 2
Total 6875
EthnicityNumber of Patients having at least
1 Review
Non-Maori 5389
Maori 1221
Missing 265
Total 6875
6610
Number of Practices
VLCA Funding
Other Funding Rural Urban PN:GP≥1 PN:GP<1
34 44 32 46 38 40
Practice Characteristics
Univariate
statistical analysis was performed using Mantel-Haenszel estimates of odds ratio
1 DARRetained (n=5861) Māori
Non-Māori Total
Odds Ratio 95% CI
Age 60 yrs and over 4,369 3,872 88% 91% 90% 2.60 2.24-3.02
Age 59 yrs and under 2,241 1,989 74% 80% 79%
Male 3,289 2,904 79% 88% 87% 1.05 0.91-1.22
Female 3,319 2,955 81% 87% 86%
PN:GP >1 3,406 2,999 82% 89% 88% 1.33 1.15-1.54
PN:GP <1 3,204 2,862 78% 87% 85%
Rural Practice 2,469 2,250 82% 89% 88% 1.27 1.09-1.48
Urban Practice 4,141 3,611 79% 87% 85%
VLCA Funding 2,746 2,460 80% 88% 86% 1.10 0.94-1.27
Other Funding 3,864 3,401 80% 88% 87%
Non-Māori 5,389 4,786 88% 1.70 1.43-2.02
Māori 1,221 1,075 80%
[RK1]Gary/ross throught on n here
Multivariate
Odds Ratio 95% CI
Age 60+ 2.44 2.08 – 2.84
PN:GP 1+ 1.30 1.12 – 1.51
Non-Māori 1.41 1.18 – 1.70
Discussion
• Patient– Age – more time? Better understanding?– Māori/Non-Māori – relationship with service?
• Practice– PN:GP ratio – nurse led process?– Rural – know patient better?
Discussion
• Cross sectional aligns with this definition of retention
• Practice factors are important
• Patient factors are important
Thanks
• Prof Ross Lawrenson, Waikato Clinical School, University of Auckland
• Ben Amey (SAS programming)• Ass. Prof. Dharma Arunchalam,
Monash University (Statistical advice)• Janet Amey• You
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