The Prognosis and Healthcare Expenditure of Newly Diagnosed Diabetic Patients - Are There Differences Between Family Physicians and the Internists?

Abstract

Objective: Diabetes has become a global epidemic and its related complications also contribute to staggering medical expenditure. This is a longitudinal cohort study utilizing the National Health Insurance Research Database of Taiwan. The aim of this study is to analyze the probability of family physicians and internists in the primary healthcare system in encountering diabetic acute emergencies and chronic comorbidities as well as the difference in medical expenditure. Methods: Subjects aged 18 or above visiting local clinics with initial diagnosis of diabetes mellitus between November 2002 and December 2004 as well as at least two visits with diabetes diagnoses within 12 months were included. The primary healthcare system should cover at least 50% of their diabetes-related clinical visits. Exclusion criteria included diabetes-related diagnosis prior to the initial diagnosis and/or the concomitant diagnosis of serious illnesses. The whole study period included years being followed until December 31, 2007. Results: Kaplan-Meier survival analysis was conducted to evaluate the risk of developing acute as well as chronic complications between two cohorts (SAS 9.2). Totally 1,273 and 989 patients aged between 18 and 75 were recruited for the family medicine cohort and internal medicine cohort, respectively. Conclusions: Our study revealed no differences in the reported incidences of most diabetes-associated complications between the family physicians and internists. Besides, the average cost of outpatient care by family physicians was significantly lower than that by internists. The results, therefore, underscore the capability of primary care family physicians to provide cost-effective care for diabetic patients.