Increasing comorbidity linked to poorer care quality for older people with diabetes
medwireNews: The quality of care among older adults with diabetes declines with increasing comorbidity and is particularly low for those with both osteoarthritis and major depression, population-based study data show.
Walter Wodchis (University of Toronto, Ontario, Canada) and co-investigators therefore call for “more targeted interventions and collaboration between healthcare providers to improve quality of care and reduce hospitalization” in these patients.
The study included data for 273,592 people aged 65 years and older with diabetes and comorbid hypertension; 141,947 with comorbid hypertension and chronic ischemic heart disease; 255,214 with comorbid osteoarthritis; and 2444 with comorbid osteoarthritis and major depression.
Of these, 15.6%, 24.8%, 19.5%, and 29.0% were hospitalized for any cause during the 4-year study period.
The team found that having one or two glycated hemoglobin (HbA1c) tests per year was associated with a significant 7–12% lower risk for all-cause hospitalization than having none, but their data also showed that people with two comorbid conditions were less likely to undergo this level of HbA1c testing than those with one comorbid condition.
Specifically, the testing rates were 43.3% and 45.4% for comorbid hypertension with and without chronic ischemic heart disease, respectively, and 39.4% and 45.0% for comorbid osteoarthritis with and without major depression, respectively.
A similar pattern was observed for the use of oral antihypoglycemic drugs.
Median levels of continuity of care, measured using the BICE index, were also lower among people with two versus one comorbidities, yet having a continuity of care value above the median level was associated with a 16–30% lower risk for hospitalization.
In all groups, the risk for all-cause hospitalization increased by 5–6% with each additional prescribed drug, and the researchers note that the mean number of drugs prescribed increased with increasing comorbidity and was higher among the patients with diabetes-discordant versus-concordant conditions.
Indeed, the mean number of drugs prescribed to people with comorbid osteoarthritis and major depression was 17.1 compared with 12.1 among those with only osteoarthritis and 13.4 and 10.6 in the participants with comorbid hypertension with and without chronic ischemic heart disease, respectively.
Writing in BMJ Open, Wodchis and co-authors say their findings highlight a “need for focusing on improving continuity of care and prioritising treatment in older adults with diabetes with any multiple conditions but especially in those with diabetes-discordant conditions (eg, depression).”
They add that their data could “help inform clinicians and policy makers in developing strategies for subpopulations at risk.”
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