Evaluating variations in medical practice between government primary care health centres

  • M.C Gulliford
    Corresponding author. E-mail address:(M.C. Gulliford)
    Department of Public Health Sciences, GKT School of Medicine, Kings College London, Capital House, 42 Weston St, London SE1 3QD UK
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  • D Mahabir
    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
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  • O.C Ukoumunne
    Department of Medical Statistics and Evaluation, Imperial College School of Medicine, The Hammersmith Hospital, Du Cane Rd London W12 0NN UK
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      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.


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