Changes in health services usage associated with insulin initiation in primary care
Samuel Johnson A B , Sharmala Thuraisingam A , John Furler A and Jo-Anne Manski Nankervis A
+ Author Affiliations
- Author Affiliations
A Department of General Practice, The University of Melbourne, 200 Berkeley Street, Carlton, Vic. 3053, Australia.
B Corresponding author. Email: samuelj12987@gmail.com
Australian Journal of Primary Health 24(2) 155-161 https://doi.org/10.1071/PY17152
Submitted: 26 October 2017 Accepted: 5 December 2017 Published: 16 March 2018
Abstract
Insulin initiation is often delayed in primary care partly because of clinician concerns about the additional clinical work. This study describes health services usage (HSU) pre- and post-insulin initiation in people with type 2 diabetes and out-of-target glycaemic levels. Secondary analysis of participant data from the Stepping Up randomised controlled trial of a model of care for insulin initiation in general practice was undertaken. For 142 people who commenced insulin, HSU in the 6 months prior was compared to that in the 12 months following insulin initiation. Overall, HSU events increased in the 6 months following insulin initiation from a median (IQR) of 18 (15, 29) to 23 (16, 36); (P = 0.05), mostly because of an increase in general practitioner (GP) consultations (6 (4, 10) to 8 (5, 11); (P = 0.01)). HSU and GP consultations subsequently returned to baseline at 12 months. There was no effect on hospitalisations or specialist consultations. Insulin initiation is associated with a small increase in GP consultations that reverts to baseline after 12 months without affecting other health services. This study can inform health services planning and resource allocation at practice and health policy levels to support insulin initiation in general practice.
Additional keywords: general practice, health services usage, insulin initiation, type 2 diabetes.
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