Exploring geographic variation of and influencing factors for utilization of four diabetes management measures in Swiss population using claims data

Wei, Wenjia and Gruebner, Oliver and von Wyl, Viktor and Dressel, Holger and Ulyte, Agne and Brüngger, Beat and Blozik, Eva and Bähler, Caroline and Braun, Julia and Schwenkglenks, Matthias. (2020) Exploring geographic variation of and influencing factors for utilization of four diabetes management measures in Swiss population using claims data. BMJ Open Diabetes Research & Care, 8 (1). e001059.

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Official URL: https://edoc.unibas.ch/81611/

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Four strongly recommended diabetes management measures are biannual glycated hemoglobin (HbA1c) testing, annual eye examination, kidney function examination, and low-density lipoprotein (LDL) testing in patients below 75 years. We aimed to describe regional variation in the utilization of the four measures across small regions in Switzerland and to explore potential influencing factors.; We conducted a cross-sectional study of adult patients with drug-treated diabetes in 2014 using claims data. Four binary outcomes represented adherence to the recommendations. Possible influencing factors included sociodemographics, health insurance preferences, and clinical characteristics. We performed multilevel modeling with Medstat regions as the higher level. We calculated the median odds ratio (MOR) and checked spatial autocorrelation in region level residuals using Moran's I statistic. When significant, we further conducted spatial multilevel modeling.; Of 49 198 patients with diabetes (33 957 below 75 years), 69.6% had biannual HbA1c testing, 44.3% each had annual eye examination and kidney function examination, and 55.5% of the patients below 75 years had annual LDL testing. The effects of health insurance preferences were substantial and consistent. Having any supplementary insurance (ORs across measures were between 1.08 and 1.28), having supplementary hospital care insurance (1.08-1.30), having chosen a lower deductible level (eg, SFr2500 compared with SFr300: 0.57-0.69), and having chosen a managed care model (1.04-1.17) were positively associated with recommendations adherence. The MORs (1.27-1.33) showed only moderate unexplained variation, and we observed inconsistent spatial patterns of unexplained variation across the four measures.; Our findings indicate that the uptake of strongly recommended measures in diabetes management could possibly be optimized by providing further incentives to patients and care providers through insurance scheme design. The absence of marked regional variation implies limited potential for improvement by targeted regional intervention, while provider-specific promotion may be more impactful.
Faculties and Departments:03 Faculty of Medicine > Departement Public Health > Pharmazeutische Medizin ECPM > Pharmazeutische Medizin (Szucs)
UniBasel Contributors:Schwenkglenks, Matthias
Item Type:Article, refereed
Article Subtype:Research Article
Publisher:BMJ Publishing Group
Note:Publication type according to Uni Basel Research Database: Journal article
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Last Modified:12 Apr 2021 12:21
Deposited On:12 Apr 2021 12:21

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