Rates and estimated cost of primary care consultations in people diagnosed with type 2 diabetes and comorbidities: A retrospective analysis of 8.9 million consultations.

Coles, Briana; Zaccardi, Francesco; Seidu, Sam; Gillies, Clare L; Davies, Melanie J; Hvid, Christian; Khunti, Kamlesh

AIMS To determine whether telephone and face to face primary care consultation rates, costs, and temporal trends during 2000-2018 differed by the number of comorbidities in people with type 2 diabetes (T2DM). METHODS 120,409 adults with newly diagnosed T2DM from 2000-2018 were classified by the number of prevalent and incident comorbidities. Face to face and telephone primary care consultations with a nurse or physician were obtained. Crude and sex-age adjusted annual consultation rates and associated costs were calculated based on the number of comorbidities at the time of consultation. RESULTS The crude rate of face to face primary care consultations for patients without comorbidities was 10.3 (95% CI 10.3-10.4) per person year, 12.7 (12.7-12.7) for 1 comorbidity, 15.1 (15.1-15.2) for 2 comorbidities, and 18.7 (18.7-18.8) for 3 or more comorbidities. The mean annual inflation-adjusted cost for face to face consultations was £412.70 per patient without comorbidities, £516.80 for 1 comorbidity, £620.75 for 2 comorbidities, and £778.83 for 3 or more comorbidities. The age-sex adjusted face to face consultation rate changed an average of -3.3% (95% CI -4.4% to -2.3%) per year from 2000 to 2018 for patients without comorbidities, -2.7% (-4.0% to -1.3%) for 1 comorbidity, -2.2% (-3.3% to -1.2%) for 2 comorbidities, and -4.3% (-8.7% to +0.3%) for 3 or more comorbidities. CONCLUSIONS Though consultation rates for all patients decreased from 2000-2018, there was a significant disparity between the rate for patients with and without comorbidities. Patients with T2DM but and comorbidities may require different models of service delivery. This article is protected by copyright. All rights reserved.