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The following is a summary of “Impact of patient registration on utilisation and quality of care: a propensity score matching and staggered difference-in-differences analysis of a cohort of 16,775 people with type 2 diabetes,” published in the July 2024 issue of Primary Care by Moran et al.
In 2012, Luxembourg implemented a Referring Doctor (RD) policy to enhance patient care by having individuals voluntarily register with a primary care practitioner, coordinating their healthcare and ensuring comprehensive follow-up. This study seeks to address the sparse evidence on the impact of patient registration by evaluating the RD policy’s effects on the care of patients with type 2 diabetes (PWT2D).
Researchers analyzed data from 16,775 PWT2D individuals enrolled with the Luxembourg National Fund between 2010 and 2018. The evaluation focused on several metrics, including the utilization of primary and specialist outpatient care, quality of care indicators, and prescribed medication reimbursements over both short-term (until 2015) and medium-term (until 2018) periods. The study group employed propensity score matching to compare patients with and without RD registration and used difference-in-difference methods to account for variations in registration timing.
The findings indicate a low enrollment rate of PWT2D in the RD program. The analysis revealed that the parallel trends assumption was not met for several indicators, including general practitioner (GP) consultations, GP home visits (medium-term), HbA1c tests (short-term), complete cholesterol tests (short-term), kidney function (urine) tests (short-term), and repeat prescribed cardiovascular medicines (short-term). Nonetheless, there were significant increases observed in several areas: HbA1c tests (medium-term: 0.09 [95% CI: 0.01 to 0.18]), kidney function (blood) tests (short-term: 0.10 [95% CI: 0.01 to 0.19]; 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 (short-term: 0.19 [95% CI: 0.03 to 0.36]; medium-term: 0.18 [95% CI: 0.02 to 0.34]), and repeat prescribed cardiovascular medicines (medium-term: 0.08 [95% CI: 0.01 to 0.15]). Sensitivity analyses further indicated 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]), alongside 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]).
In conclusion, the RD program had a modest effect on the quality of care (QoC) indicators and managing prescribed medications for PWT2D. Future research should expand beyond this cohort and incorporate clinical outcomes and socio-economic factors to comprehensively evaluate the policy’s impact.
Source: bmcprimcare.biomedcentral.com/articles/10.1186/s12875-024-02505-2
