Researchers say more funding is needed for general practices which serve patients with high needs, after their study of a Porirua practice showed a quarter of the patients had been diagnosed with diabetes, or prediabetes.
The researchers studied the health care provided to the more than 4,700 adult patients enrolled at the Porirua Union and Community Health Service in Cannons Creek, an area of high socioeconomic deprivation, over a 12-month period between 1 April, 2022 and 31 March, 2023.
The results are published in the New Zealand Medical Journal.
Lead researcher Dr Christine Barthow from the University of Otago, Wellington, says one of the most striking findings was that people with prediabetes were similar to patients with diabetes in having a number of other long-term health conditions which needed to be managed.
Dr Christine Barthow
“Prediabetes is often viewed as simply a risk state, but we found that many people already had complex health needs before diabetes was diagnosed,” she says.
Compared with people with normal blood sugar levels, those with prediabetes and diabetes used healthcare services more frequently. People with diabetes had nearly twice as many consultations, three times as many prescriptions, and substantially higher rates of emergency department visits and potentially preventable hospital admissions.
The research was co-led by Porirua Union and Community Health Service GP Dr Bryan Betty.
He says government funding for primary health care needs to be better targeted to reflect the complexity and intensity of care required in communities with high-needs patients.
Dr Bryan Betty
“Most of the health care for people with type 2 diabetes, prediabetes and multiple long-term conditions is provided through general practice, but these services are under increasing strain.
“The pressure is particularly acute in practices which serve mainly patients with greater clinical complexity or who experience socioeconomic deprivation.”
Dr Betty says early diagnosis, consistent monitoring and timely intervention is important both for patients with diabetes and for those at risk of developing the disease to prevent adverse outcomes.
Almost 350,000 New Zealanders have diabetes and this number is expected to rise to half a million by 2044.
Dr Barthow says there are significant inequities in terms of the impact of diabetes on New Zealanders.
“People living in the most socioeconomically deprived areas are 2.7 times more likely to develop diabetes than those in the least deprived areas, and people of Pacific, Indian/South Asian, or Māori descent have a significantly higher incidence than those of European descent.
“Ensuring primary health care is properly funded to manage high-needs patients really is vital if we are to improve population health outcomes and reduce inequities.”
The research was funded by the Health Research Council.
The research paper, ‘Health complexity, metabolic health, and service use in a high-need primary care population in Aotearoa New Zealand: a cross-sectional study’ is published in the New Zealand Medical Journal.