Objective: To recognize the difference of patient care offered by primary care family physician, internist and generalist, according to the incidence rate of the acute complications, time to event interval of the chronic complications and the cost of OPD, admission and emergency care. Method: The first diagnosed diabetes patients were extracted from the National Health Insurance database, utilizing data from 2001 to 2007 to fit the criteria. Patients with catastrophic illness and who attended to the primary care clinic less than 20% of total OPD visits were excluded. The incidence rate of DM acute complications such as hypoglycemia, NKHS and DKA, and the time to event interval of DM chronic complications such as CAD, stroke, DM nephropathy, DM retinopathy, polyneuropathy and DM peripheral artery disease were investigated. Furthermore, the cost of OPD visit, emergency care and hospital admission was also evaluated. Result: The patients cared by primary care family physician tended to get hypoglycemia more frequently, but less likely to get hyperglycemic complications including both DKA and NKHS.The family physician did not recognize the large vessel complications well but can effectively control the diabetic neuropathy and diabetic nephropathy. Compare to those cared by internist, the patients cared by family physician have the lower expense on diabetic related OPD visit, but a little higher on emergency and admission. Totally, the patients cared by family physician have the lowest cost compared to internist and generalist, but without significant difference. Conclusion: The cost of OPD visit was significantly lower in patient cared by primary care family physician compared to internist without sacrifice the quality of care. Further study was necessary due to the limitation of the application of secondary database.

Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.

Information technology [IT] that enables electronic access to patient health records has been widely recognized as a promising means to improve the quality of care for patients with chronic diseases, and reduce health care costs through better health information delivery and encouragement of self-management. IT applied to assist chronic disease management is inadequately studied in Canadian health care settings. This thesis describes the development and modest pilot implementation of an electronic tool, the Diabetes Complication Surveillance System [DCSS]. The DCSS was conceived as a self-monitoring tool that facilitates regular checks on conditions of diabetes patients, including acute and long-term complications. The DCSS is relatively unusual, as it facilitates glycemic control and also allows patients to address the long-term complications of diabetes. The development of the DCSS involved literature reviews and consultations with clinician experts. Questionnaire results from the pilot provided positive feedback.

科学研究費補助金 研究種目:基盤研究(A)(2) 課題番号:11306009 研究代表者:大澤 俊彦 研究期間:1999-2000年度