Is having a regular provider of diabetes care related to intensity of care and glycemic control?

@article{citeulike:765078, abstract = {BACKGROUND: We investigated whether having a regular health care provider for diabetes was related to the intensity of care, use of preventive services, or glycemic control in a well-defined population of adults with diabetes. METHODS: Adults with diabetes who were continuously enrolled in a health maintenance organization (HMO) for 1 year were identified by diagnostic and pharmacy databases (estimated sensitivity = 0.91, positive predictive value = 0.94). In a stratified random sample, 1828 patients were sent a survey by mail that had a corrected response rate of 85.6\%. Further data on utilization of services and glycosylated hemoglobin values were obtained from administrative databases and linked to survey responses. RESULTS: HMO members who reported having a regular health care provider (RP) for their diabetes (N = 1243) were comparable with those (N = 144) who denied having such a provider (NRP) in age, race, sex, comorbidity, and years of education, but had longer-duration diabetes (10.9 years vs 8.3 years; P = .002). After adjusting for age, sex, education level, duration of diabetes, and type of HMO clinic (owned vs contracted), RP subjects were more likely than NRPs (all P < .001) to follow a special diet for patients with diabetes (55\% vs 33\%), regularly monitor glucose levels at home (68\% vs 47\%), have greater frequency of glycosylated hemoglobin (Hb A1c) testing (65\% vs 38\%), have more foot examinations (42\% vs 17\%), have recommended cholesterol checks (77\% vs 63\%), and have had a recent preventive examination (86\% vs 68\%). Smaller differences favoring having a regular provider were noted for insulin use (48\% vs 33\%, odds ratio [OR] = 1.71, P = .013), for an influenza immunization within 1 year (65\% vs 51\%, P = .029), and for dilated retinal examinations (64\% vs 51\%, P < .027). No differences between groups were noted for dental checkups (69\% vs 67\%, P = .724) or likelihood of endocrinology referral (17\% vs 10\%, P = .104). Mean Hb A1c level was 8.2\% (normal is < 6.1\%) in the RP group and 8.6\% in the NRP group (P = .182). Twelve percent of RPs and 24\% of NRPs had an Hb A1c level of greater than 10\% (chi 2 = 3.7, OR = 0.48, P = .05) after adjusting for age, sex, duration of diabetes, and education level. CONCLUSIONS: After adjustment for case mix, patients with diabetes who identified a regular primary health care provider for their diabetes were more likely to receive most recommended elements of diabetes care and to have better glycemic control than patients without such a provider. This effect was partially, but not completely, mediated by a higher number of clinic visits for those with a regular health care provider. Innovators seeking to improve diabetes care should be mindful of the relationship between having a regular primary health care provider and the quality of diabetes care.}, address = {HealthPartners Research Foundation, Minneapolis, MN 55440-1309, USA.}, author = {O'Connor, P. J. and Desai, J. and Rush, W. A. and Cherney, L. M. and Solberg, L. I. and Bishop, D. B. }, citeulike-article-id = {765078}, issn = {0094-3509}, journal = {J Fam Pract}, keywords = {diabetes, provider}, month = {October}, number = {4}, pages = {290--297}, posted-at = {2006-07-19 20:09:50}, priority = {2}, title = {Is having a regular provider of diabetes care related to intensity of care and glycemic control?}, url = {http://view.ncbi.nlm.nih.gov/pubmed/9789515}, volume = {47}, year = {1998} }

TY - JOUR ID - citeulike:765078 L3 - citeulike-article-id:765078 TI - Is having a regular provider of diabetes care related to intensity of care and glycemic control? JF - J Fam Pract VL - 47 IS - 4 SP - 290 EP - 297 AD - HealthPartners Research Foundation, Minneapolis, MN 55440-1309, USA. SN - 0094-3509 N2 - BACKGROUND: We investigated whether having a regular health care provider for diabetes was related to the intensity of care, use of preventive services, or glycemic control in a well-defined population of adults with diabetes. METHODS: Adults with diabetes who were continuously enrolled in a health maintenance organization (HMO) for 1 year were identified by diagnostic and pharmacy databases (estimated sensitivity = 0.91, positive predictive value = 0.94). In a stratified random sample, 1828 patients were sent a survey by mail that had a corrected response rate of 85.6%. Further data on utilization of services and glycosylated hemoglobin values were obtained from administrative databases and linked to survey responses. RESULTS: HMO members who reported having a regular health care provider (RP) for their diabetes (N = 1243) were comparable with those (N = 144) who denied having such a provider (NRP) in age, race, sex, comorbidity, and years of education, but had longer-duration diabetes (10.9 years vs 8.3 years; P = .002). After adjusting for age, sex, education level, duration of diabetes, and type of HMO clinic (owned vs contracted), RP subjects were more likely than NRPs (all P < .001) to follow a special diet for patients with diabetes (55% vs 33%), regularly monitor glucose levels at home (68% vs 47%), have greater frequency of glycosylated hemoglobin (Hb A1c) testing (65% vs 38%), have more foot examinations (42% vs 17%), have recommended cholesterol checks (77% vs 63%), and have had a recent preventive examination (86% vs 68%). Smaller differences favoring having a regular provider were noted for insulin use (48% vs 33%, odds ratio [OR] = 1.71, P = .013), for an influenza immunization within 1 year (65% vs 51%, P = .029), and for dilated retinal examinations (64% vs 51%, P < .027). No differences between groups were noted for dental checkups (69% vs 67%, P = .724) or likelihood of endocrinology referral (17% vs 10%, P = .104). Mean Hb A1c level was 8.2% (normal is < 6.1%) in the RP group and 8.6% in the NRP group (P = .182). Twelve percent of RPs and 24% of NRPs had an Hb A1c level of greater than 10% (chi 2 = 3.7, OR = 0.48, P = .05) after adjusting for age, sex, duration of diabetes, and education level. CONCLUSIONS: After adjustment for case mix, patients with diabetes who identified a regular primary health care provider for their diabetes were more likely to receive most recommended elements of diabetes care and to have better glycemic control than patients without such a provider. This effect was partially, but not completely, mediated by a higher number of clinic visits for those with a regular health care provider. Innovators seeking to improve diabetes care should be mindful of the relationship between having a regular primary health care provider and the quality of diabetes care. KW - diabetes KW - provider AU - O'Connor, PJ AU - Desai, J AU - Rush, WA AU - Cherney, LM AU - Solberg, LI AU - Bishop, DB PY - 1998/10// UR - http://view.ncbi.nlm.nih.gov/pubmed/9789515 ER -