Abstract
BackgroundPrevious studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices. However, in these studies inter-practice variation was calculated without controlling for clustering of patients within practices and without adjusting for patient and practice characteristics. Therefore, in the present study inter-practice variation of diagnosed hypertension and diabetes mellitus prevalence rates was calculated by 1) using a multi-level design and 2) adjusting for patient and practice characteristics.MethodsData were used from the Netherlands Information Network of General Practice (LINH) in 2004. Of all 168.045 registered patients, the presence of hypertension, diabetes mellitus and all available ICPC coded symptoms and diseases related to hypertension and diabetes, were determined. Also, the characteristics of practices were used in the analyses. Multilevel logistic regression analyses were performed.ResultsThe 95% prevalence range for the practices for the prevalence of diagnosed hypertension and diabetes mellitus was 66.3 to 181.7 per 1000 patients and 22.2 to 65.8 per 1000 patients, respectively, after adjustment for patient and practice characteristics. The presence of hypertension and diabetes was best predicted by patient characteristics. The most important predictors of hypertension were obesity (OR = 3.5), presence of a lipid disorder (OR = 3.0), and diabetes mellitus (OR = 2.6), whereas the presence of diabetes mellitus was particularly predicted by retinopathy (OR = 8.5), lipid disorders (OR = 2.8) and hypertension (OR = 2.7).ConclusionAlthough not the optimal case-mix could be used in this study, we conclude that even after adjustment for patient (demographic variables and risk factors for hypertension and diabetes mellitus) and practice characteristics (practice size and presence of a practice nurse), there is a wide difference between general practices in the prevalence rates of diagnosed hypertension and diabetes mellitus.
Highlights
Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices
All Dutch inhabitants are listed with a general practice and generally the General Practitioner (GP) is the first professional to be consulted for health problems
It could be hypothesized that when all GPs are following these guidelines, there should be no variance between general practices, i.e. inter-practice variation, in the prevalence rates of diagnosed hypertension and diabetes mellitus after adjustment for patient characteristics in a practice
Summary
Previous studies of inter-practice variation of the prevalence of hypertension and diabetes mellitus showed wide variations between practices In these studies interpractice variation was calculated without controlling for clustering of patients within practices and without adjusting for patient and practice characteristics. In the present study interpractice variation of diagnosed hypertension and diabetes mellitus prevalence rates was calculated by 1) using a multi-level design and 2) adjusting for patient and practice characteristics. It could be hypothesized that when all GPs are following these guidelines, there should be no variance between general practices, i.e. inter-practice variation, in the prevalence rates of diagnosed hypertension and diabetes mellitus after adjustment for patient characteristics in a practice. Demographic characteristics of the patients in a general practice, like age and gender, can influence the prevalence rates of diagnosed hypertension and diabetes mellitus in a practice, but the prevalence rates can be affected by an unequal distribution of risk factors between populations of different practices
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