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Original research
Association between GP participation in a primary care group and monitoring of biomedical and lifestyle target indicators in people with type 2 diabetes: a cohort study (ELZHA cohort-1)
  1. Sytske van Bruggen1,2,
  2. Simone P Rauh3,
  3. Tobias N Bonten1,
  4. Niels H Chavannes1,
  5. Mattijs E Numans1,
  6. Marise J Kasteleyn1
  1. 1Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Chronical Care, Hadoks, The Hague, The Netherlands
  3. 3Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
  1. Correspondence to Mrs Sytske van Bruggen; s.van_bruggen{at}


Objective Whether care group participation by general practitioners improves delivery of diabetes care is unknown. Using ‘monitoring of biomedical and lifestyle target indicators as recommended by professional guidelines’ as an operationalisation for quality of care, we explored whether (1) in new practices monitoring as recommended improved a year after initial care group participation (aim 1); (2) new practices and experienced practices differed regarding monitoring (aim 2).

Design Observational, real-life cohort study.

Setting Primary care registry data from Eerstelijns Zorggroep Haaglanden (ELZHA) care group.

Participants Aim 1: From six new practices (n=538 people with diabetes) that joined care group ELZHA in January 2014, two practices (n=211 people) were excluded because of missing baseline data; four practices (n=182 people) were included. Aim 2: From all six new practices (n=538 people), 295 individuals were included. From 145 experienced practices (n=21 465 people), 13 744 individuals were included.

Exposure Care group participation includes support by staff nurses on protocolised diabetes care implementation and availability of a system providing individual monitoring information. ‘Monitoring as recommended’ represented minimally one annual registration of each biomedical (HbA1c, systolic blood pressure, low-density lipoprotein) and lifestyle-related target indicator (body mass index, smoking behaviour, physical exercise).

Primary outcome measures Aim 1: In new practices, odds of people being monitored as recommended in 2014 were compared with baseline (2013). Aim 2: Odds of monitoring as recommended in new and experienced practices in 2014 were compared.

Results Aim 1: After 1-year care group participation, odds of being monitored as recommended increased threefold (OR 3.00, 95% CI 1.84 to 4.88, p<0.001). Aim 2: Compared with new practices, no significant differences in the odds of monitoring as recommended were found in experienced practices (OR 1.21, 95% CI 0.18 to 8.37, p=0.844).

Conclusions We observed a sharp increase concerning biomedical and lifestyle monitoring as recommended after 1-year care group participation, and subsequently no significant difference between new and experienced practices—indicating that providing diabetes care within a collective approach rapidly improves registration of care.

  • general diabetes
  • protocols & guidelines
  • quality in health care
  • primary care
  • organisation of health services

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See:

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  • Contributors SvB analysed data and wrote the manuscript. SR analysed data and reviewed the manuscript. TNB reviewed the manuscript. NC reviewed the manuscript and contributed to the discussion. MEN is the guarantor of this work and, as such, had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. MJK reviewed and edited the manuscript and contributed to the discussion.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Patient consent for publication Not required.

  • Ethics approval Medical Ethical Committee of the Leiden University Medical Center (code G16.102).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Data are available upon reasonable request to the corresponding author.

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