Membership in a diabetes-care network and adherence to clinical practice guidelines for treating type 2 diabetes among general practitioners: A four-year follow-up

• General practitioners belonging to diabetes care networks adhered more closely to diabetes care guidelines.
• Results were clinically relevant only for HbA1C and microalbuminuria assays.
• This improvement benefited all patients with diabetes, not only with the network patients.
• Results suggest existence of a halo effect.

ObjectivesTo assess whether private general practitioners (GPs) belonging to a diabetes-care network adhered more closely to clinical practice guidelines for diabetes care than GPs not in such a network, for all their patients with type 2 diabetes treated with medication (patients with diabetes), regardless of whether they received care through a network (that is, whether a halo effect occurred).Research design and measuresThe study, based on health insurance reimbursement databases in southeastern France, included 468 GPs in two networks and 468 non-network GPs in the same geographical area, matched one-to-one by propensity scores. We followed up their patients with diabetes (n = 22,808) from 2008 through 2011, conducting multivariate time-to-event analyses (Cox models) that took the matching design into account to evaluate time from inclusion until performance of the given number of each of six recommended examinations/tests.ResultsGPs belonging to a diabetes-care network adhered more closely to clinical practice guidelines but our result were slightly pronounced. Hazard ratios (HR) were significantly higher for patients of network GPs for the implementation of 3 HbA1C assays (HRa = 1.13; [95%CI = 1.10–1.16]), or 1 microalbuminuria assay (1.4 [1.35–1.45]); they were lower for LDL-cholesterol assays (1.04 [1.01–1.07]) and ophthalmological checkups (1.07 [1.04–1.10]), and not significant for creatinemia or cardiac monitoring.ConclusionsNetwork GPs had better diabetes monitoring practices for all their patients with diabetes than the other GPs, especially for the most diabetes-specific tests. Further research is needed in other settings to confirm the existence of this halo effect.