Dossier n. 179/2009 [Abstract] Care profiles and costs for diabetic people in Emilia-Romagna

Diabetes Mellitus is a common chronic condition associated with early morbidity and mortality on affected population. The management of diabetes and of its complications requires a substantial portion of resource utilization and a suitable health policy approach. In 2003 the “Clinical Guidelines for Management of Diabetes Mellitus” was released in Emilia-Romagna Region and a new organizational model based on integrated care management of type-2 diabetes patients was emphasised at Local Health Trusts’ level.

The availability and the quality of health electronic databases in Emilia-Romagna Region have remarkably increased over the last years. Based on low-cost and systematic recording of figures, the aim of this work was to estimate diabetes prevalence in population, the frequency of certain major complications related to diabetes and the utilization of health resources in terms of hospitalization, pharmacy and speciality consumption, using standard procedures applied to administrative data (Hospital Discharge Data, Mortality Register, Pharmaceutical Prescription and Outpatient Specialty Care).

Through the analysis of data from the regional Informative System, attention is focused in particular on demographic characteristics of adult diabetic population (over 35 years of age) in the 2005-2007 period, on the most frequent clinical complications, on the utilization of heath resources in terms of hospitalization rates, specialty care, drug consumption.

In the observation period, diabetes prevalence in adults is stable, higher in males, in line with national data indicated by the Italian Institute of Statistics. While macrovascular complications (ischemic cardiopathy, heart failure, stroke, peripheral arterial disease) show a constant prevalence, microvascular complications show a slightly increasing trend in renal complications and dialysis use, but are stable in cataract surgery and retinopathies. Despite the variable use of the recommended procedures for disease control (such as glycated haemoglobin or examination of fundus oculi), a significant increase in health consumption is registered, in particular due to outpatient specialty care and drug prescriptions.

Chapter 5 on health costs highlights that in 2007 in Emilia-Romagna 18% of total expenditure was for diabetic patients, that use 3 times more resources than non diabetic people; expenses are much higher in case of some frequent problems like heart failure, ocular and kidney complications. Hospitalization and pharmaceutical expenditure accounts for more than 80% of total expenses.

The survey method proposed in the study, that is based on administrative informative data currently available at Health Trusts, represents a useful tool to elaborate clinical-epidemiological evaluations and to systematically monitor morbidity and resource consumption for diabetes. Its main features are the possibility to analyze variability among different geographical areas considering not only frequency measures but mainly care services supplied, and the possibility to assess clinical outcomes and economic and organizational impact of diabetes through specific indicators.

These functions are necessary to a Regional Health System involved in acquiring and monitoring data to better manage relevant pathologies of its population.