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Achievement of Processes of Care for Patients with Type 2 Diabetes in General Medical Clinics and Specialist Diabetes Clinics in Thailand

Sokha Sieng, Bandit Thinkamrop and Cameron Hurst

Background: The process of care used for type 2 diabetes are common clinical performance indicators, but comparing achievement of process of care between clinic types at different hospital types has received little attention. This study compares process of diabetes care between specialist diabetes clinics (SDCs) and general medical clinics (GMCs), and how this disparity may vary across hospital types (regional, provincial, community) in Thailand.

Methods: We conducted a cross-sectional study based on medical records of type 2 diabetes patients (n=26,860) collected from 595 hospitals (26 regional, 70 provincial, 499 provincial) between April 1 to June 30, 2012 across all provinces in Thailand. Generalized linear mixed models were used to investigate the association between clinic type and processes of care. Processes of care outcomes included the "FACE of diabetes" where F is foot examination, A is HbA1c examination, C is low density lipoprotein cholesterol (LDL-C) examination, and E is eye examination. Aggregate measure including All FACE (yes/no), whether all four clinical examinations were achieved, and Any FACE (yes/no), whether any were achieved, were also examined.

Results: SDCs were often better at large hospitals, and only for LDL-C exam were SDCs not superior in this setting. For regional hospitals, SDCs exhibited higher achievement of All FACE (OR regional=1.68, 95%CI: 1.26-2.24). For provincial hospitals, SDCs were associated with higher odds of achieving All FACE and Any FACE (OR=2.14, 95%CI: 1.50-3.06; OR=1.76, 95%CI: 1.05-2.97, respectively). For community hospitals, no difference in achievement of All FACE and Any FACE could be demonstrated between clinics types.

Conclusions: SDCs perform better in process of care (singular or aggregated) than GMCs at regional and provincial hospitals, for all process of care indicators, and were never inferior. However, smaller community hospital- GMCs perform care no worse than their SDCs counterparts.