Journal of Clinical Epidemiology
Volume 54, Issue 5 , Pages 511-517, May 2001

Evaluating variations in medical practice between government primary care health centres

  • M.C Gulliford

      Affiliations

    • Department of Public Health Sciences, GKT School of Medicine, Kings College London, Capital House, 42 Weston St, London SE1 3QD UK
    • Corresponding Author InformationCorresponding author. E-mail address:(M.C. Gulliford)
    • ,
  • D Mahabir

      Affiliations

    • Nutrition and Metabolism Division, Ministry of Health, Laventille, Trinidad and Tobago , Imperial College School of Medicine, The Hammersmith Hospital, Du Cane Rd London W12 0NN UK
    • ,
  • O.C Ukoumunne

      Affiliations

    • Department of Medical Statistics and Evaluation, Imperial College School of Medicine, The Hammersmith Hospital, Du Cane Rd London W12 0NN UK

Received 2 January 2000; received in revised form 21 September 2000; accepted 30 September 2000.

Abstract 

We evaluated variations in medical care for diabetes among government health centres in Trinidad and Tobago. Data were analysed for 1579 subjects with clinical diabetes attending 23 health centres concerning 12 processes of care and six case-mix or outcome variables. Random effects models were used for analysis. Health centre level variation was appreciable. Intraclass correlations ranged from 0.025 to 0.316 for process of care variables and 0.000 to 0.056 for case-mix variables. Compared with health centres with only one nurse, patients attending those with three or more nurses received 1.18 (95% confidence interval 0.27 to 2.09) more processes of care. Delivery of medical care varied among the health centres and those with higher staffing levels provided more processes of care.

Keywords:  Primary care, Variations in medical care, West Indies, Random effects model, Diabetes mellitus

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PII: S0895-4356(00)00336-X

Journal of Clinical Epidemiology
Volume 54, Issue 5 , Pages 511-517, May 2001

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