BACKGROUND: Although preventing diabetes complications requires long-term management, little is known about which patients persistently fail to get recommended care. OBJECTIVE: To determine the frequency and correlates of persistent, long-term gaps in diabetes care. METHOD: : The study population included 8392 patients with diabetes. Patient surveys and medical records from 10 health plans over 3 years provided data on socioeconomic characteristics, access to care, social support, and mental and physical health, and diabetes preventive care services. We defined a "persistent gap" as a participant's missing a preventive care service for the entire 3 years. Services considered included hemoglobin A1c, cholesterol, and albuminuria tests, and foot and dilated eye examinations. RESULTS: Thirty percent of participants had at least 1 persistent gap. The most common gaps were lipid testing (11.6%), microalbuminuria testing (9.7%), and eye examinations (9.0%). Persistent gaps were 18% to 42% higher for young patients, lean persons, those with low income, employed persons, smokers, those with diabetes less than 5 years, and patients with none or 1 comorbid conditions. Sex, education, marital status, family demands, transportation, trust in physicians, and mental health were not associated with gaps in care. CONCLUSIONS: Persistent gaps in diabetes care are common even among insured patients. Patients with lower income, younger age, fewer years of diabetes, having fewer comorbidities, taking fewer medications, and poor health behaviors are vulnerable to persistent gaps in care and a group who warrant targeted interventions to improve preventive diabetes care.
BACKGROUND: Although preventing diabetes complications requires long-term management, little is known about which patients persistently fail to get recommended care. OBJECTIVE: To determine the frequency and correlates of persistent, long-term gaps in diabetes care. METHOD: : The study population included 8392 patients with diabetes. Patient surveys and medical records from 10 health plans over 3 years provided data on socioeconomic characteristics, access to care, social support, and mental and physical health, and diabetes preventive care services. We defined a "persistent gap" as a participant's missing a preventive care service for the entire 3 years. Services considered included hemoglobin A1c, cholesterol, and albuminuria tests, and foot and dilated eye examinations. RESULTS: Thirty percent of participants had at least 1 persistent gap. The most common gaps were lipid testing (11.6%), microalbuminuria testing (9.7%), and eye examinations (9.0%). Persistent gaps were 18% to 42% higher for young patients, lean persons, those with low income, employed persons, smokers, those with diabetes less than 5 years, and patients with none or 1 comorbid conditions. Sex, education, marital status, family demands, transportation, trust in physicians, and mental health were not associated with gaps in care. CONCLUSIONS: Persistent gaps in diabetes care are common even among insured patients. Patients with lower income, younger age, fewer years of diabetes, having fewer comorbidities, taking fewer medications, and poor health behaviors are vulnerable to persistent gaps in care and a group who warrant targeted interventions to improve preventive diabetes care.
Authors: Susan L Norris; Phyllis J Nichols; Carl J Caspersen; Russell E Glasgow; Michael M Engelgau; Leonard Jack; George Isham; Susan R Snyder; Vilma G Carande-Kulis; Sanford Garfield; Peter Briss; David McCulloch Journal: Am J Prev Med Date: 2002-05 Impact factor: 5.043
Authors: E W Gregg; L S Geiss; J Saaddine; A Fagot-Campagna; G Beckles; C Parker; W Visscher; T Hartwell; L Liburd; K M Narayan; M M Engelgau Journal: Am J Prev Med Date: 2001-10 Impact factor: 5.043
Authors: Chien-Wen Tseng; Edward F Tierney; Robert B Gerzoff; R Adams Dudley; Beth Waitzfelder; Ronald T Ackermann; Andrew J Karter; John Piette; Jesse C Crosson; Quyen Ngo-Metzger; Richard Chung; Carol M Mangione Journal: Diabetes Care Date: 2007-11-13 Impact factor: 19.112
Authors: Howard H Moffet; Melissa M Parker; Urmimala Sarkar; Dean Schillinger; Alicia Fernandez; Nancy E Adler; Alyce S Adams; Andrew J Karter Journal: Am J Manag Care Date: 2011-05 Impact factor: 2.229
Authors: Woolton Lee; Jennifer T Lloyd; Katherine Giuriceo; Timothy Day; William Shrank; Rahul Rajkumar Journal: Health Serv Res Date: 2020-07-27 Impact factor: 3.402
Authors: Ludovic Casanova; Sébastien Cortaredona; Jean Gaudart; Odile Launay; Philippe Vanhems; Patrick Villani; Pierre Verger Journal: BMJ Open Date: 2017-08-18 Impact factor: 2.692
Authors: Marit de Jong; Sanne A E Peters; Rianneke de Ritter; Carla J H van der Kallen; Simone J S Sep; Mark Woodward; Coen D A Stehouwer; Michiel L Bots; Rimke C Vos Journal: Front Endocrinol (Lausanne) Date: 2021-03-30 Impact factor: 6.055