Author:
McKay Rachel,Letarte Laurence,Lebel Alexandre,Quesnel-Vallée Amélie,Vanasse Alain,Bartlett Gillian,Blais Lucie,Buckeridge David,Choinière Manon,Hudon Catherine,Lacasse Anaïs,Lamarche Benoit,Lebel Alexandre,Quesnel-Vallée Amélie,Roberge Pasquale,Émond Valérie,Pomey Marie-Pascale,Benigeri Mike,Cloutier Anne-Marie,Dorais Marc,Courteau Josiane,Courteau Mireille,Plante Stéphanie,Cambon Pierre,Giguère Annie,Leroux Isabelle,St-Laurent Danielle,Roy Denis,Borja Jaime,Néron André,Landry Geneviève,Ethier Jean-François,Dault Roxanne,Côté-Marcil Marc-Antoine,Tremblay Pier,Quirion Sonia,
Abstract
Abstract
Background
Social inequalities in complications associated with diabetes mellitus persist. As a primary care sensitive condition (PCSC), this association could be related to differential access to primary care. Our objectives are to establish a typology of care trajectories following a new diagnosis, and to explore social determinants of trajectories.
Methods
We used the TorSaDe (The Care Trajectories-Enriched Data) cohort, which links Canadian Community Health Survey respondents to health administrative data. Care trajectories were mapped over a two-year period following a new diagnosis and analysed using state sequence and clustering methods. Associations between individual and geographic characteristics with trajectory types were assessed with multinomial logistic regression.
Results
Three trajectories were identified: Regular Family Physician (FP) Predominant, Specialist Physician Predominant, and Few Services. With Regular FP as the reference, males had higher odds of experiencing the Few Services trajectory, higher education was associated with higher odds of both the Few Services and the Specialist trajectories, and immigrants had higher odds of the Specialist trajectory. Diagnoses in a physician’s office, as opposed to in hospital, were associated with higher odds of the Regular FP trajectory.
Conclusions
The Regular FP trajectory most closely aligns with the management principles of the PCSC approach. We did not find strong evidence of social status privileging access to this trajectory. However, the association with location of diagnosis suggests that efforts to ensure patients diagnosed in hospital are well linked to a regular family physician for follow up may help to reduce unnecessary specialist use and meet PCSC goals.
Publisher
Springer Science and Business Media LLC
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