Abstract
BackgroundSocial inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories.MethodsWe used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression.ResultsThree trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experiencing the Few Services trajectory, higher education was associated with higher odds of both the Few Services and the Specialist trajectories, and immigrants had higher odds of the Specialist trajectory. Diagnoses in a physician’s office, as opposed to in hospital, were associated with higher odds of the Regular FP trajectory.ConclusionsThe Regular FP trajectory most closely aligns with the management principles of the PCSC approach. We did not find strong evidence of social status privileging access to this trajectory. However, the association with location of diagnosis suggests that efforts to ensure patients diagnosed in hospital are well linked to a regular family physician for follow up may help to reduce unnecessary specialist use and meet PCSC goals.
Highlights
The global prevalence of diabetes has been on the rise for the past several decades [1]
Considered a primary care sensitive condition (PCSC) [4], effective management is highly contingent on timely access to quality primary care, and notably continuity of care (CoC), which is characterised by an ongoing, cooperative relationship between a patient and their physician-led care team [5]
We aimed to explore care trajectories defined by states of care as ascribed to interactions across the health care system, in order to better represent the order, timing, and continuity of care
Summary
The global prevalence of diabetes has been on the rise for the past several decades [1]. Primary care for quality diabetes care Good control of diabetes (maintaining an average HbA1c below 6.5%, 48 mmol/mol) in the first year following a diabetes diagnosis has been associated with reduced risk of complications and death 10 years later, even after adjusting for glycemic control after the first year [3]. This “legacy effect” of early control highlights the importance of ensuring patients are appropriately connected to support and service resources following diagnosis. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories
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