DIABETES-MELLITUS AND HEALTH-SERVICE UTILIZATION - A CASE-CONTROL STUDY OF OUTPATIENT VISITS 8 YEARS AFTER DIAGNOSIS

All incident cases of diabetes mellitus in the age group 15 to 34 year s have been prospectively registered in Sweden since January 1983. To analyse the utilization of outpatient services 8 years after disease o nset, we selected the cases registered in 1983 and two controls per ca se from the general population, matched by age, gender, and county of residence. In 1991, retrospective data about utilization patterns duri ng a 3-month period were collected via a mailed questionnaire, returne d by 317 (72%) patients with diabetes and 586 (68%) controls. Seventy- four percent of the cases and 19% of the controls reported at least on e visit to a hospital outpatient clinic, including accident and emerge ncy departments. The odds ratio for one visit was 14 (95% CI 9.6-20), for two visits 11 (95% CI 7.0-18), and for three or more visits 8.9 (9 5% CI 5.6-14). Even when specialized diabetes clinics were excluded fr om the analysis, the cases had higher odds for visits to internal medi cine clinics, to ophthalmology clinics, and to gynaecology clinics, bu t not for visits to surgical clinics or to accident and emergency depa rtments. Of non-hospital outpatient services, only visits to nurse pra ctitioners were reported by a higher percentage of diabetic responders . Twenty-seven percent of patients with diabetes, as compared to 9% of the controls, had visited both hospital and non-hospital outpatient o ffices. Females were overrepresented among diabetic high-consumers. Th e results indicate that most young to middle-aged Swedish persons with diabetes are monitored at hospital outpatient offices, but considerab le overlap exists between hospital and non-hospital outpatient service s. Further research is needed into the determinants of utilization pat terns in diabetes, such as gender.