Diabetic Retention in the National ‘Get Checked’ Programme

Dr Rawiri Keenan

Janet Amey

Prof. Ross Lawrenson

Outline

• What is MHN?

• Why we chose to do the study

• Methods

• Results/Discussion

MHN

• Tairawhiti, Taupo, Waikato, Peak & Hauora

• 102 general practice teams

• 17,500 coded diabetics in 2009/10

Why more diabetes research?

• High profile

• New lens, old problem

• Research registrar

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

QP vs Cohort retention

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

Questions?