Type 2 Diabetes Management in Aotearoa New Zealand: A Comparison of Urban and Rural Primary Care Clinics.
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| Názov: | Type 2 Diabetes Management in Aotearoa New Zealand: A Comparison of Urban and Rural Primary Care Clinics. |
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| Autori: | Mustafa S; Division of Health, University of Waikato, Hamilton, New Zealand., Rodrigues M; Division of Health, University of Waikato, Hamilton, New Zealand., Lawrenson R; Division of Health, University of Waikato, Hamilton, New Zealand., Scott-Jones J; Pinnacle Primary Healthcare Organisation, Waikato, New Zealand., Papa V; Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand., Zhao J; Division of Health, University of Waikato, Hamilton, New Zealand., Crosswell R; Division of Health, University of Waikato, Hamilton, New Zealand., Kenealy T; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand., Murphy R; Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.; Te Whatu Ora Health New Zealand Te Toka Tumai, Auckland, New Zealand., Keenan R; Division of Health, University of Waikato, Hamilton, New Zealand., Moffitt A; Procare Health Limited, Auckland, New Zealand., Paul R; Division of Health, University of Waikato, Hamilton, New Zealand.; Te Whatu Ora Health New Zealand Waikato, Hamilton, New Zealand., Chepulis L; Division of Health, University of Waikato, Hamilton, New Zealand. |
| Zdroj: | The Australian journal of rural health [Aust J Rural Health] 2025 Oct; Vol. 33 (5), pp. e70098. |
| Spôsob vydávania: | Journal Article; Observational Study; Comparative Study |
| Jazyk: | English |
| Informácie o časopise: | Publisher: Wiley-Blackwell Publishing Asia Country of Publication: Australia NLM ID: 9305903 Publication Model: Print Cited Medium: Internet ISSN: 1440-1584 (Electronic) Linking ISSN: 10385282 NLM ISO Abbreviation: Aust J Rural Health Subsets: MEDLINE |
| Imprint Name(s): | Publication: Amidale : Wiley-Blackwell Publishing Asia Original Publication: Armidale : Association for Australian Rural Nurses, c1992- |
| Výrazy zo slovníka MeSH: | Diabetes Mellitus, Type 2*/therapy , Diabetes Mellitus, Type 2*/drug therapy , Diabetes Mellitus, Type 2*/ethnology , Primary Health Care*/statistics & numerical data , Rural Health Services*/statistics & numerical data , Rural Population*/statistics & numerical data , Urban Health Services*/statistics & numerical data, Humans ; New Zealand ; Middle Aged ; Male ; Cross-Sectional Studies ; Female ; Adult ; Aged ; Adolescent ; Young Adult ; Urban Population/statistics & numerical data |
| Abstrakt: | Objective: To examine the demographic differences between individuals with Type 2 Diabetes (T2D) enrolled in rural and urban clinics and evaluate the quality of care they receive. Design: Cross-sectional observational study. Setting: Primary care data from four large Primary Healthcare Organisations across the Auckland and Waikato regions of New Zealand. Participants: Patients aged 18-75 years with T2D from February 2021 to August 2022. Main Outcomes Measures: Associations between rurality and sociodemographic variables, clinical measures, and prescribing rates. Results: A total of 56 937 patients with T2D were included, with 85.3% enrolled in urban practices and 14.7% in rural. Rural clinics had a significantly higher proportion of Māori individuals than urban clinics (31.4% vs. 17.4%). Patients in rural clinics had lower but not clinically significant reductions in mean HbA1c, LDL-c, blood pressure, and eGFR than those in urban clinics; however, the number of laboratory tests completed during the study period was lower in rural clinics. Māori were less likely to receive HbA1c and uACR tests than non-Māori. Clinically indicated prescribing for metformin (79.1% vs. 72.5%), ACE inhibitors (80.5% vs. 75.2%), and statins (61.2% vs. 54.4%) was higher in patients enrolled in urban than rural clinics (all p < 0.05), and regression showed lower odds of insulin (OR: 0.65, 95% CI: 0.61-0.69) and SGLT2i/GLP1RA (OR: 0.87, 95% CI: 0.82-0.93) prescribing in rural clinics (both p < 0.001). Conclusion: Targeted strategies are needed to address the disparities in T2D care for patients in rural clinics, as well as Māori, particularly optimizing medication prescribing and laboratory tests to improve overall care. (© 2025 The Author(s). Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.) |
| References: | BMC Health Serv Res. 2015 Apr 11;15:154. (PMID: 25889993) Aust J Rural Health. 2021 Dec;29(6):939-946. (PMID: 34494690) J Am Geriatr Soc. 2016 Jan;64(1):e1-7. (PMID: 26626408) Lancet. 2007 Oct 20;370(9596):1453-7. (PMID: 18064739) BMC Public Health. 2023 Nov 20;23(1):2290. (PMID: 37985982) BMC Med Educ. 2019 Aug 14;19(1):311. (PMID: 31412928) J Prim Health Care. 2025 Mar;17(1):53-62. (PMID: 40152956) Soc Sci Med. 2001 Dec;53(11):1491-502. (PMID: 11710424) Aust J Rural Health. 2025 Oct;33(5):e70098. (PMID: 41024742) Lancet Reg Health West Pac. 2022 Aug 18;28:100570. (PMID: 36042896) Int J Equity Health. 2023 May 4;22(1):79. (PMID: 37143152) N Z Med J. 2005 May 20;118(1215):U1475. (PMID: 15915194) Lancet Glob Health. 2021 Feb;9(2):e209-e217. (PMID: 33069275) J Prim Health Care. 2009 Dec;1(4):261-9. (PMID: 20690334) Rural Remote Health. 2024 May;24(2):8674. (PMID: 38697785) Aust N Z J Public Health. 2020 Jun;44(3):193-200. (PMID: 32311187) Public Health. 2012 Oct;126(10):813-20. (PMID: 22922043) J Prim Health Care. 2020 Dec;12(4):318-326. (PMID: 33349319) Soc Sci Med. 2021 Nov;288:113231. (PMID: 32741687) BMC Prim Care. 2023 Aug 21;24(1):162. (PMID: 37605190) Med J Aust. 2012 Jul 2;197(1):32-6. (PMID: 22762229) Curr Diab Rep. 2015 Jun;15(6):608. (PMID: 25948497) N Z Med J. 2024 Mar 22;137(1592):9-13. (PMID: 38513199) N Z Med J. 2023 Apr 28;136(1574):93-97. (PMID: 37501235) N Z Med J. 2007 May 04;120(1253):U2519. (PMID: 17514220) BMJ Open. 2012 Jun 08;2(3):. (PMID: 22685219) N Z Med J. 2022 Aug 5;135(1559):24-40. (PMID: 35999779) J Epidemiol Community Health. 2023 Sep;77(9):571-577. (PMID: 37295927) |
| Grant Information: | 21/839 Health Research Council of New Zealand |
| Contributed Indexing: | Keywords: access to medications; chronic disease management; health inequity; healthcare access; primary healthcare |
| Entry Date(s): | Date Created: 20250930 Date Completed: 20250930 Latest Revision: 20251114 |
| Update Code: | 20251115 |
| PubMed Central ID: | PMC12481175 |
| DOI: | 10.1111/ajr.70098 |
| PMID: | 41024742 |
| Databáza: | MEDLINE |
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Nájsť tento článok vo Web of Science | Abstrakt: | Objective: To examine the demographic differences between individuals with Type 2 Diabetes (T2D) enrolled in rural and urban clinics and evaluate the quality of care they receive.<br />Design: Cross-sectional observational study.<br />Setting: Primary care data from four large Primary Healthcare Organisations across the Auckland and Waikato regions of New Zealand.<br />Participants: Patients aged 18-75 years with T2D from February 2021 to August 2022.<br />Main Outcomes Measures: Associations between rurality and sociodemographic variables, clinical measures, and prescribing rates.<br />Results: A total of 56 937 patients with T2D were included, with 85.3% enrolled in urban practices and 14.7% in rural. Rural clinics had a significantly higher proportion of Māori individuals than urban clinics (31.4% vs. 17.4%). Patients in rural clinics had lower but not clinically significant reductions in mean HbA1c, LDL-c, blood pressure, and eGFR than those in urban clinics; however, the number of laboratory tests completed during the study period was lower in rural clinics. Māori were less likely to receive HbA1c and uACR tests than non-Māori. Clinically indicated prescribing for metformin (79.1% vs. 72.5%), ACE inhibitors (80.5% vs. 75.2%), and statins (61.2% vs. 54.4%) was higher in patients enrolled in urban than rural clinics (all p < 0.05), and regression showed lower odds of insulin (OR: 0.65, 95% CI: 0.61-0.69) and SGLT2i/GLP1RA (OR: 0.87, 95% CI: 0.82-0.93) prescribing in rural clinics (both p < 0.001).<br />Conclusion: Targeted strategies are needed to address the disparities in T2D care for patients in rural clinics, as well as Māori, particularly optimizing medication prescribing and laboratory tests to improve overall care.<br /> (© 2025 The Author(s). Australian Journal of Rural Health published by John Wiley & Sons Australia, Ltd on behalf of National Rural Health Alliance Ltd.) |
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| ISSN: | 1440-1584 |
| DOI: | 10.1111/ajr.70098 |