Associations between attainment of incentivised primary care indicators and incident diabetic retinopathy in England: a population-based historical cohort study

BMC Medicine

Laura H. Gunn¹  Ailsa J. McKay¹  Thirunavukkarasu Sathish¹  Eszter Vamos¹  Azeem Majeed¹  German Molina¹  Sobha Sivaprasad²  Manjula Nugawela² 

[1] Department of Primary Care and Public Health, Imperial College London;Institute of Ophthalmology, UCL and NIHR Moorfields Biomedical Retinal Research, UCL and Moorfields Eye Hospital;

关键词: Type 2 Diabetes;    Retinopathy;    General Practice;    Glycated haemoglobin;    Blood pressure;    Cholesterol;   

DOI  :  10.1186/s12916-021-01966-x

来源: DOAJ

【 摘 要 】

Abstract Background The associations between England’s incentivised primary care-based diabetes prevention activities and hard clinical endpoints remain unclear. We aimed to examine the associations between attainment of primary care indicators and incident diabetic retinopathy (DR) among people with type 2 diabetes. Methods A historical cohort (n = 60,094) of people aged ≥ 18 years with type 2 diabetes and no DR at baseline was obtained from the UK Clinical Practice Research Datalink (CPRD). Exposures included attainment of the Quality and Outcomes Framework (QOF) HbA1c (≤ 7.5% or 59 mmol/mol), blood pressure (≤ 140/80 mmHg), and cholesterol (≤ 5 mmol/L) indicators, and number of National Diabetes Audit (NDA) care processes completed (categorised as 0–3, 4–6, or 7–9), in 2010–2011. Outcomes were time to development of DR and sight-threatening diabetic retinopathy (STDR). Nearest neighbour propensity score matching was undertaken and Cox proportional hazards models then fitted using the matched samples. Concordance statistics were calculated for each model. Results 8263 DR and 832 STDR diagnoses were observed over mean follow-up periods of 3.5 (SD 2.1) and 3.8 (SD 2.0) years, respectively. HbA1c and blood pressure (BP) indicator attainment were associated with lower rates of DR (adjusted hazard ratios (aHRs) 0.94 (95% CI 0.89–0.99) and 0.87 (0.83–0.92), respectively), whereas cholesterol indicator attainment was not (aHR 1.03 (0.97–1.10)). All QOF indicators were associated with lower rates of STDR (aHRs 0.74 (0.62–0.87) for HbA1c, 0.78 (0.67–0.91) for BP, and 0.82 (0.67–0.99) for cholesterol). Completion of 7–9 vs. 0–3 NDA processes was associated with fewer STDR diagnoses (aHR 0.72 (0.55–0.94)). Conclusions Attainment of key primary care indicators is associated with lower incidence of DR and STDR among patients with type 2 diabetes in England.

【 授权许可】

Unknown