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Medicina is published by MDPI from Volume 54 Issue 1 (2018). Articles in this Issue were published by another publisher in Open Access under a CC-BY (or CC-BY-NC-ND) licence. Articles are hosted by MDPI on mdpi.com as a courtesy and upon agreement with Lithuanian Medical Association, Lithuanian University of Health Sciences, and Vilnius University.
Open AccessArticle

The Effect of Continuous Monitoring of Hypertension and Type 2 Diabetes Mellitus on the Number of Visits to Medical Specialists and Hospitalization: a Retrospective Study

by Ruth Kalda 1,* and 2
1
Department of Family Medicine, University of Tartu
2
Estonian Health Insurance Fund, Estonia
*
Author to whom correspondence should be addressed.
Medicina 2013, 49(11), 77; https://doi.org/10.3390/medicina49110077
Received: 28 October 2013 / Accepted: 30 November 2013 / Published: 5 December 2013
Objective. The aim of the study was to determine whether the implementation of the quality system (QS) in primary healthcare made the care of chronically ill patients in family practice more consistent and reduced the load in specialized medical care.
Material and Methods. A quantitative retrospective cohort study using the database of the Es- tonian Health Insurance Fund was provided. Patients with diagnosed essential hypertension (HYP) and/or type 2 diabetes mellitus (DM2) formed the study group. If the family physician met the criteria for the monitoring of patients with DM2 and HYP set in the QS, the result was defined as positive. The number of disease-specific hospitalizations, the length of hospital stay, and the num- ber of visits to family physicians and medical specialists due to HYP or DM2 in 2005-2008 were evaluated.
Results
. Chronically ill patients (DM2 and HYP) in the lists of family physicians with a posi- tive QS result were 1.26 times more likely (95% CI, 1.25-1.28) to be continuously monitored than those in the lists of family physicians with a negative QS result. The 2 coexisting chronic diseases (DM2 and HYP) increased the chance of being continuously monitored and increased the number of visits. The chance of being monitored by a medical specialist alone was reduced if the family phy- sician participated in the QS (OR, 0.66; 95% CI, 0.64-0.69) and had a rural practice (OR, 0.53; 95% CI, 0.51-0.55) and if the patient was a woman and older and had a diagnosis of HYP alone. The participation of family physicians in the QS reduced the hospitalization risk (OR, 0.9; 95% CI, 0.88-0.94) as well as the number of hospitalizations for the patients with HYP (OR, 0.93; 95% CI, 0.87-0.99).
Conclusions. The implementation of the QS in primary healthcare reduces the load in specialized medical care. A more detailed analysis of the effect of the QS on the workload and the organization of family practice as well as on the patients' morbidity and satisfaction could be done in the near future.
Keywords: quality system; primary healthcare; monitoring of chronically ill patients quality system; primary healthcare; monitoring of chronically ill patients
MDPI and ACS Style

Kalda, R.; Vastra, K. The Effect of Continuous Monitoring of Hypertension and Type 2 Diabetes Mellitus on the Number of Visits to Medical Specialists and Hospitalization: a Retrospective Study. Medicina 2013, 49, 77.

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1
Only visits after 24 November 2015 are recorded.
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