To assess the effectiveness of care in general practice for people with diabetes.
Meta-analysis of randomised trials comparing general practice and shared care with follow up in hospital outpatient clinic.
Identification : Trials were identified from searches of eight bibliographic and research databases.
Five trials identified included 1058 people with diabetes, overall mean age 58.4 years, receiving hospital outpatient follow up for their diabetes.
In shared care schemes featuring more intensive support through a computerised prompting system for general practitioners and patients, there was no difference in mortality between care in hospital and care in general practice (odds ratio 1.06,95% confidence interval 0.53 to 2.11) ; glycated haemoglobin tended to be lower in primary care (weighted difference in means of - 0.28%, - 0.59% to 0.03%) ; and losses to follow up were significantly lower in primary care (odds ratio 0.37,0.22 to 0.61).
However, schemes with less well developed support for family doctors were associated with adverse outcomes for patients.
Unstructured care in the community is associated with poorer follow up, worse glycaemic control, and greater mortality than in hospital care. (...)
Mots-clés Pascal : Diabète, Homme, Médecine générale, Métaanalyse, Pratique professionnelle, Soin santé primaire, Hôpital, Etude comparative, Traitement, Efficacité traitement, Surveillance, Mortalité, Royaume Uni, Europe, Endocrinopathie
Mots-clés Pascal anglais : Diabetes mellitus, Human, Internal medicine, Metaanalysis, Professional practice, Primary health care, Hospital, Comparative study, Treatment, Treatment efficiency, Surveillance, Mortality, United Kingdom, Europe, Endocrinopathy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0404202
Code Inist : 002B21E01C. Création : 25/01/1999.