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Receipt of Diabetes Preventive Services Differs by Insurance Status at Visit

Published:November 06, 2014DOI:https://doi.org/10.1016/j.amepre.2014.08.035

      Background

      Lack of insurance is associated with suboptimal receipt of diabetes preventive care. One known reason for this is an access barrier to obtaining healthcare visits; however, little is known about whether insurance status is associated with differential rates of receipt of diabetes care during visits.

      Purpose

      To examine the association between health insurance and receipt of diabetes preventive care during an office visit.

      Methods

      This retrospective cohort study used electronic health record and Medicaid data from 38 Oregon community health centers. Logistic regression was used to test the association between insurance and receipt of four diabetes services during an office visit among patients who were continuously uninsured (n=1,117); continuously insured (n=1,466); and discontinuously insured (n=336) in 2006–2007. Generalized estimating equations were used to account for within-patient correlation. Data were analyzed in 2013.

      Results

      Overall, continuously uninsured patients had lower odds of receiving services at visits when due, compared to those who were continuously insured (AOR=0.73, 95% CI=0.66, 0.80). Among the discontinuously insured, being uninsured at a visit was associated with lower odds of receipt of services due at that visit (AOR=0.77, 95% CI=0.64, 0.92) than being insured at a visit.

      Conclusions

      Lack of insurance is associated with a lower probability of receiving recommended services that are due during a clinic visit. Thus, the association between being uninsured and receiving fewer preventive services may not be completely mediated by access to clinic visits.
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      References

        • Vijan S.
        • Stevens D.L.
        • Herman W.H.
        • Funnell M.M.
        • Standiford C.J.
        Screening, prevention, counseling, and treatment for the complications of type II diabetes mellitus. Putting evidence into practice.
        J of Gen Intern Med. 1997; 12: 567-580
        • Gaede P.
        • Vedel P.
        • Larsen N.
        • Jensen G.V.
        • Parving H.H.
        • Pedersen O.
        Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes.
        N Engl J Med. 2003; 348: 383-393
        • Harris R.
        • Donahue K.
        • Rathore S.S.
        • Frame P.
        • Woolf S.H.
        • Lohr K.N.
        Screening adults for type 2 diabetes: a review of the evidence for the U.S. Preventive Services Task Force.
        Ann Intern Med. 2003; 138: 215-229
        • Meier M.
        • Hummel M.
        Cardiovascular disease and intensive glucose control in type 2 diabetes mellitus: moving practice toward evidence-based strategies.
        Vasc Health Risk Manag. 2009; 5: 859-871
        • USDHHS
        National Healthcare Quality Report, 2011. (AHRQ Publication No. 12-0005.).
        Agency for Healthcare Research and Quality, Rockville MD2012
        • Ng J.H.
        • Kaftarian S.J.
        • Tilson W.M.
        • et al.
        Self-reported delays in receipt of health care among women with diabetes and cardiovascular conditions.
        Womens Health Issues. 2010; 20: 316-322
        • DeVoe J.
        • Graham A.
        • Angier H.
        • Baez A.
        • Krois L.
        Obtaining healthcare services for low-income children: a hierachy of needs.
        J Health Care Poor Underserved. 2008; 19: 1192-1211
        • Robinson J.M.
        • Shavers V.
        The role of health insurance coverage in cancer screening utilization.
        J Health Care Poor Underserved. 2008; 19: 842-856
        • USDHHS
        National Healthcare Disparities Report, 2011. (AHRQ Publication No. 12-0006.).
        Agency for Healthcare Research and Quality, Rockville MD2012
        • Gold R.
        • DeVoe J.
        • Shah A.
        • Chauvie S.
        Insurance continuity and receipt of diabetes preventive care in a network of federally qualified health centers.
        Med Care. 2009; 47: 431-439
        • Nelson K.M.
        • Chapko M.K.
        • Reiber G.
        • Boyko E.J.
        The association between health insurance coverage and diabetes care; data from the 2000 Behavioral Risk Factor Surveillance System.
        Health Serv Res. 2005; 40: 361-372
        • Zhang J.X.
        • Huang E.S.
        • Drum M.L.
        • et al.
        Insurance status and quality of diabetes care in community health centers.
        Am J Public Health. 2009; 99: 742-747
        • Devoe J.E.
        • Gold R.
        • Spofford M.
        • et al.
        Developing a network of community health centers with a common electronic health record: description of the Safety Net West Practice-based Research Network (SNW-PBRN).
        J Am Board Fam Med. 2011; 24: 597-604
        • Oladele C.R.
        • Barnett E.
        Racial/ethnic and social class differences in preventive care practices among persons with diabetes.
        BMC Public Health. 2006; 6: 259
        • Gold R.
        • DeVoe J.E.
        • McIntire P.J.
        • Puro J.E.
        • Chauvie S.L.
        • Shah A.R.
        Receipt of diabetes preventive care among safety net patients associated with differing levels of insurance coverage.
        J Am Board Fam Med. 2012; 25: 42-49
        • Jerant A.
        • Fiscella K.
        • Tancredi D.J.
        • Franks P.
        Health insurance is associated with preventive care but not personal health behaviors.
        J Am Board Fam Med. 2013; 26: 759-767
        • Pande A.H.
        • Ross-Degnan D.
        • Zaslavsky A.M.
        • Salomon J.A.
        Effects of healthcare reforms on coverage, access, and disparities: quasi-experimental analysis of evidence from Massachusetts.
        Am J Prev Med. 2011; 41: 1-8
        • Long S.K.
        • Stockley K.
        • Grimm E.
        • Coyer C.
        National findings on access to health care and service use for non-elderly adults enrolled in Medicaid.
        Medicaid and CHIP Payment and Access Commission (MACPAC Contractor Report No. 2). Urban Institute, Washington DC2012
        • Carlson M.J.
        • Devoe J.
        • Wrigbt B.J.
        Short-term impacts of coverage loss in a Medicaid population: Early results from a prospective cohort study of the Oregon Health Plan.
        Ann Fam Med. 2006; 4: 391-398
        • Schoen C.
        • DesRoches C.
        Uninsured and unstably insured: the importance of continuous insurance coverage.
        Health Serv Res. 2000; 35: 187-206
        • Kasper J.D.
        • Giovannini T.A.
        • Hoffman C.
        Gaining and losing health insurance: strengthening the evidence for effects on access to care and health outcomes.
        Med Care Res Rev. 2000; 57 (discussion 319–25): 298-318
        • Berk M.L.
        • Schur C.L.
        Access to care: how much difference does Medicaid make?.
        Health Aff (Millwood). 1998; 17: 169-180
        • Zhang X.
        • Bullard K.M.
        • Gregg E.W.
        • et al.
        Access to health care and control of ABCs of diabetes.
        Diabetes Care. 2012; 35: 1566-1571
        • Wright B.J.
        • Carlson M.J.
        • Edlund T.
        • DeVoe J.
        • Gallia C.
        • Smith J.
        The impact of increased cost sharing on Medicaid enrollees.
        Health Aff (Millwood). 2005; 24: 1106-1116
        • American Diabetes Assocation
        Standards of Medical Care–2013.
        Diabetes Care. 2013; 36: S11-S66
        • Song Z.
        • Safran D.G.
        • Landon B.E.
        • et al.
        The “Alternative Quality Contract,” based on a global budget, lowered medical spending and improved quality.
        Health Aff (Milwood). 2012; 31: 1885-1894
        • Hu F.B.
        • Goldberg J.
        • Hedeker D.
        • Flay B.R.
        • Pentz M.A.
        Comparison of population-averaged and subject-specific approaches for analyzing repeated binary outcomes.
        Am J Epidemiol. 1998; 147: 694-703
        • Zhang X.
        • Geiss L.S.
        • Cheng Y.J.
        • Beckles G.L.
        • Gregg E.W.
        • Kahn H.S.
        The missed patient with diabetes: how access to health care affects the detection of diabetes.
        Diabetes Care. 2008; 31: 1748-1753
        • Voorhees K.
        • Fernald D.H.
        • Emsermann C.
        • et al.
        Underinsurance in primary care: a report from the State Networks of Colorado Ambulatory Practices and Partners (SNOCAP).
        J Am Board Fam Med. 2008; 21: 309-316
        • CDC
        Vital signs: health insurance coverage and health care utilization—United States, 2006--2009 and January-March 2010.
        MMWR Morb Mortal Wkly Rep. 2010; 59: 1448-1454
        • Hinman A.R.
        • Orenstein W.A.
        • Rodewald L.
        Financing immunizations in the United States.
        Clin Infect Dis. 2004; 38: 1440-1446
        • Ahmad F.S.
        • Tsang T.
        Diabetes prevention, health information technology, and meaningful use: challenges and opportunities.
        Am J Prev Med. 2013; 44: S357-S363
        • DeVoe J.E.
        Being uninsured is bad for your health: can medical homes play a role in treating the uninsurance ailment?.
        Ann Fam Med. 2013; 11: 473-476
        • Meyers D.S.
        • Mishori R.
        • McCann J.
        • Delgado J.
        • O׳Malley A.S.
        • Fryer E.
        Primary care physicians׳ perceptions of the effect of insurance status on clinical decision making.
        Ann Fam Med. 2006; 4: 399-402
        • Devoe J.E.
        • Gold R.
        • McIntire P.
        • Puro J.
        • Chauvie S.
        • Gallia C.A.
        Electronic health records vs Medicaid claims: completeness of diabetes preventive care data in community health centers.
        Ann Fam Med. 2011; 9: 351-358