Rates and estimated cost of primary care consultations in people diagnosed with type 2 diabetes and comorbidities: A retrospective analysis of 8.9 million consultations

Aims

To determine whether telephone and face‐to‐face primary care consultation rates, costs, and temporal trends during 2000 to 2018 differed by the number of comorbidities in people with type 2 diabetes (T2DM).

Methods

A total of 120 409 adults with newly diagnosed T2DM between 2000 and 2018 were classified by the number of prevalent and incident comorbidities. Data on face‐to‐face and telephone primary care consultations with a nurse or physician were obtained. Crude and sex‐ and age‐adjusted annual consultation rates and associated costs were calculated based on the number of comorbidities at the time of consultation.

Results

The crude rate of face‐to‐face primary care consultations for patients without comorbidities was 10.3 (95% confidence interval [CI] 10.3‐10.4) per person‐year, 12.7 (95% CI 12.7‐12.7) for patients with one comorbidity, 15.1 (95% CI 15.1‐15.2) for those with two comorbidities, and 18.7 (95% CI 18.7‐18.8) for those with three or more comorbidities. The mean annual inflation‐adjusted cost for face‐to‐face consultations was £412.70 per patient without comorbidities, £516.80 for one comorbidity, £620.75 for two comorbidities, and £778.83 for three or more comorbidities. The age‐ and sex‐adjusted face‐to‐face consultation rate changed by an average of −3.3% (95% CI −4.4 to −2.3) per year from 2000 to 2018 for patients without comorbidities, −2.7% (95% CI −4.0 to −1.3) for those with one comorbidity, −2.2% (95% CI −3.3 to −1.2) for those with two comorbidities, and −4.3% (95% CI −8.7 to +0.3) for those with three or more comorbidities.

Conclusions

Although consultation rates for all patients decreased from 2000 to 2018, there was a significant disparity between the rate for patients with and without comorbidities. Patients with T2DM and comorbidities may require different models of service delivery.