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Quality of Preventive Care for Diabetes: Effects of Visit Frequency and Competing Demands

¹ Department of Family and Community Medicine, University of California, Davis, Sacramento, Calif
² Center for Health Studies, Group Health Cooperative, Seattle, Wash
³ Department of Psychiatry and Behavioral Sciences, University of Washington, Seattle, Wash
⁴ Department of Medicine, University of Washington, and Veterans Administration Hospital, Seattle, Wash

CORRESPONDING AUTHOR: Joshua J. Fenton, MD, MPH, Department of Family and Community Medicine, University of California, Davis, 4860 Y St, ACC 2300, Sacramento, CA 95817, joshua.fenton{at}ucdmc.ucdavis.edu

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 A_1C (HbA_1C) 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 HbA_1C 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.

Key Words: Chronic disease • disease management • preventive health services • diabetes • health services research • patient compliance • delivery of health care

This article has been cited by other articles:

				K. C. Stange In This Issue: Diabetes Quality of Care Ann. Fam. Med, January 1, 2006; 4(1): 2 - 3. [Full Text] [PDF]

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