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Prof. Dr. med. Hermann Brenner, MPH
Prof. Dr. med. Elke Raum, MPH
Heike Krämer, Dipl. Ges-Ök. MSc Epidemiologie
Deutsches Krebsforschungszentrum
Abteilung Klinische Epidemiologie und Alternsforschung
Im Neuenheimer Feld 581
69120 Heidelberg

Tel.: 06221/42 1301, 
Fax: 06221/42 1302

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Use of a supportive, telephone-based counselling system in the general practitioner's care of chronically ill persons using the example of patients with type 2 diabetes

Background:

Type 2 diabetes belongs to the most frequent diseases in GP care. Often, cardiovascular concomitant illnesses are already apparent at the time point of diagnosis. An adequate therapy in accordance with guidelines is therefore highly relevant in order to prevent or delay a quick progression of the diabetes.

Aims of the first investigations were to describe the medical care (outpatient vs. inpatient) and therapy as well as the disease status and the metabolic condition of the participants with type 2 diabetes. Moreover, by means of different regression models, gender-specific differences in medical care should be worked out, as already exist, for instance, for the indication area of heart insufficiency.

 

Materials/Methods:

In total, 1,146 participants, who were recruited through 38 GP practices in the region of Ludwigsburg-Heilbronn between October 2008 and March 2010, were included in the analyses. Information on each participant was gathered by a participant questionnaire to be filled out by the participants themselves, a physician questionnaire, and a blood sample drawn at the GP practice to determine the HbA1c value. Participants with an HbA1c > 7.5% were randomly allocated to a telephone-based counselling procedure and completed a 6-, 12- and 18-month follow-up.

 

Results /current status of the project:

An investigation of glycaemic control and self-assessed adherence to prescribed medications shows that there was a poor glycaemic control (HbA1c > 7.5%) in 36% of the men with diabetes who reported an insufficient adherence and in 17% of the men who reported a good adherence. For women with diabetes, a poor glycaemic control was apparent in 16% of the women with insufficient adherence and in 17% of the women with good adherence.

The investigation of the utilisation of medical care services by diabetics shows that in comparison to women, men visit their GP and a registered specialist less frequently and are prescribed fewer medications. The differences between the genders were strongest in the group of patients with an HbA1c > 7.5%. In terms of the frequency of inpatient stays (hospital and rehabilitation), no gender difference was found, although women with diabetes stay significantly longer in rehabilitation establishments than men with diabetes.

The investigation of gender-specific differences in the prescription of medications to treat the diabetes and cardiovascular concomitant illnesses shows that in comparison to women, men are more frequently prescribed Glitazon and oral combination preparations to treat the diabetes, and to treat the cardiovascular diseases, they more frequently receive an ACE inhibitor, a calcium channel blocker or an antithrombotic medication. Although the higher prevalence of cardiovascular diseases explains the majority of the differences, following a final adjustment, differences are still shown between the sexes for the group of ACE inhibitors and calcium channel blockers.




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