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Showing content from https://pubmed.ncbi.nlm.nih.gov/16449394/ below:

Quality of preventive care for diabetes: effects of visit frequency and competing demands

. 2006 Jan-Feb;4(1):32-9. doi: 10.1370/afm.421. Quality of preventive care for diabetes: effects of visit frequency and competing demands

Affiliations

Affiliation

¹ Department of Family and Community Medicine, University of California, Davis, Sacramento, Calif 95817, USA. joshua.fenton@ucdmc.ucdavis.edu

PMID: 16449394
PMCID: PMC1466990
DOI: 10.1370/afm.421

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Quality of preventive care for diabetes: effects of visit frequency and competing demands

Joshua J Fenton et al. Ann Fam Med. 2006 Jan-Feb.

. 2006 Jan-Feb;4(1):32-9. doi: 10.1370/afm.421. Affiliation

¹ Department of Family and Community Medicine, University of California, Davis, Sacramento, Calif 95817, USA. joshua.fenton@ucdmc.ucdavis.edu

PMID: 16449394
PMCID: PMC1466990
DOI: 10.1370/afm.421

Item in Clipboard

Abstract

Purpose: We sought to determine the association between timely receipt of diabetes-related preventive services and the longitudinal pattern of outpatient service use as characterized by a novel taxonomy that prioritized visits based on the Oregon State Prioritized Health Services List.

Methods: We performed a cross-sectional analysis of mail survey and automated health care data for a population-based sample of patients with diabetes enrolled in a health maintenance organization in Washington State (N = 4,463). Outcomes included American Diabetes Association-recommended preventive services, including regular hemoglobin A1C (HbA1C) monitoring, retinal examination, and microalbuminuria screening. Patients with fewer than 8 visits during the 2-year study period were considered infrequent users, while patients with 8 or more visits were classified as lower-priority users if most visits were for conditions of relatively low rank on the Oregon list and as higher-priority users otherwise.

Results: After adjustment for social, demographic, and clinical factors, and depression, infrequent users had significantly reduced odds of receiving at least 1 HbA1C test (odds ratio [OR] = 0.35, 95% confidence interval [CI], 0.24-0.51), retinal examination (OR = 0.74, 95% CI, 0.63-0.86), and microalbuminuria screening (OR = 0.75, 95% CI, 0.58-0.96) relative to higher-priority users during the previous year. Lower-priority users also had relatively reduced odds of receiving at least 1 HbA(1C) test (OR = 0.59, 95% CI, 0.35-1.01), retinal examination (OR = 0.68, 95% CI, 0.56-0.84), and microalbuminuria screening (OR = 0.79, 95% CI, 0.57-1.09) despite attending a similar mean number of total visits as higher-priority users.

Conclusions: Patients who attend relatively few outpatient visits or who attend more frequent visits for predominantly lower-priority conditions are more likely to receive substandard preventive care for diabetes.

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Figures
Figure 1.

Receipt of diabetes preventive services…

Figure 1.

Receipt of diabetes preventive services by patterns of use. HbA _1C = hemoblogin…

Figure 1.

Receipt of diabetes preventive services by patterns of use. HbA_1C = hemoblogin A_1C. Note: Values are rates of receipt of services over a 2-year period. Microalbuminuria screening was assessed only in patients who did not have a prescription for an angiotension-converting enzyme inhibitor at baseline. Comparison of outcomes across use patterns are statistically significant (P <.001), except for the comparison of microalbuminuria screening (P = .05).