Dijabetičar kao učestali posjetilac ordinacije obiteljske medicine

Frequent attenders (FAs) represent great workload for general practitioners. Chronic diseases are the leading cause for frequent consultations mentioned in literature. Former studies show that diabetic patients are among Fas at general practices in Croatia. Our study had three parts: A. Determination of standards for attendence at general practice offices and definition of standards for FAs in our settings. Attendence standards in general practice was calculated and followed at eight general practice offices on the sample of 4.312 patients and 58.088 visits. The patients who visited general practitioners above the average value for the upper quartilla of their age and sex groups were considered to be FAs. The study lasted from January 1, 1997 until December 31, 1999. B. Research on diabetics’ visits and factors influencing the number of their visits and the quality of health care of diabetics.Visits of 490 diabetics from 13 general practices were followed up, totally 1.170 absentees(? ) and 16.670 visits. Diabetics whose number of visits was above the limited values for the upper quartilla for age and sex group were considered to be FAs. The rest of diabetic patients not categorized as FAs represented the control group in our study. The patients were not treated by any special program apart the usual national care for diabetes. The study lasted from January 1, 1997 until December 31, 1999. C. Qualitative study of subjective factors influencing the quality of care for diabetics - FAs was performed by the method of focus group. Results. There were 4.2 visits at general practice offices in 1997 and 4.7 in 1999 in total (general) population. In 1997 22% patients did 63% of frequent consultations while in 1999 it was 65%. The number of FAs increased in three years for 16.2%. According to the above mentioned methodology we determined that 285 (60%) diabetics out of 490 were FAs.In the course of three years the number of diabetics – FAs decreased for 6 or 2.8% while the number of FAs increased for 1.6%. Epidemiologica variables like age, sex, education and marital status did not influence the frequency of consultaions by diabetic patients. Insulin dependent diabetics, patients with longer history of diabetes, patients whose main disease was diabetes, patients who are using more dugs (frequency 1.6 against low frequency 1.5), patients on self control by strips or by apparatus are more frequently FAs. The patients having the higher index of severity of multimorbid diseases according to ICB-10/ICB-9/CI (by Charlson) (frequency 1.27 against low frequency 0.99) are more frequently FAs. Diabetics with the higher index of complications severity (IDC scale) (frequency 1.37 agaist non frequency 2.62) are less frequently FAs. Multivariate analysis shows that the patients controlled by internist, those treated by the family practitioner have less chance to be frequent attenders. Specific preventive procedures: determination of microalbuminuria, determination of lipids, check up of the posterior part of the retina by ophthalmologist, foot check up, are not optimal in our conditions and are not, according to our study factors for frequent attendence. HbA1c was determined in 24% of diabetics, more in FAs. Qualitative research showed that most diabetics – FAs were visiting their doctors for referrals and drug prescriptions. They did not think of their general practitioners as of professional persons for the treatment of diabetes. They thought that general practitioners did not offer enough instructions and recommendations for the treatment of diabetes. Diabetics thought their health was good. They mentioned their fear from blindness, gangrene and insulin.Their everyday life was restricted and they were socially isolated. Several joined factors - disease, practice and health care system are making diabetic patient to be FA.