Brief ReportReceipt of Diabetes Preventive Services Differs by Insurance Status at Visit
Introduction
Preventive diabetes care decreases the risk of complications.1, 2, 3, 4 Yet, despite the effectiveness of preventive care, many patients delay or forgo recommended services.5, 6 One factor contributing to this phenomenon is lack of health insurance; uninsured people are less likely to receive healthcare services than insured,7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17 even at community health centers (CHCs) providing services at low or no cost to many uninsured patients.10, 12, 15
Lack of insurance is associated with fewer office visits.18, 19, 20, 21, 22, 23, 24 It is unclear, however, whether access to primary care visits is sufficient to ensure that uninsured patients receive needed services, or whether insurance status is related to differential receipt of care even when patients have visits. It is hypothesized that there is a significant association between insurance status and receipt of recommended diabetes services at visits when services are due.
Section snippets
Methods
This study used electronic health record (EHR) data from 38 Oregon clinics in the OCHIN network (originally called the Oregon Community Health Information Network, but shortened to OCHIN when membership expanded beyond Oregon) with fully operational EHRs by 2005. Each patient has a single medical record shared across all OCHIN network clinics.13 Adults (aged ≥18 years) with diabetes were identified who had two or more primary care visits associated with an ICD-9 code for diabetes (type 1 or 2)
Results
Demographic characteristics of the study population and visit characteristics by insurance status are shown in Table 1.
When considered in aggregate, continuously uninsured patients had lower odds of receiving services at visits when due, compared to the continuously insured (AOR=0.73, 95% CI=0.66, 0.80) (Figure 1A). When examining individual services, odds were significantly lower for all four services (HbA1c: AOR=0.86, 95% CI=0.77, 0.97; LDL: AOR=0.67, 95% CI=0.59, 0.76; microalbumin:
Discussion
Lack of health insurance is associated with poorer diabetes control.23 Previous studies10, 15, 23, 28 suggest that this could be due to uninsured patients utilizing fewer healthcare services than insured patients. This study adds new information to help explain this disparity: Even when uninsured patients use healthcare services, they are still less likely to receive recommended diabetes preventive care at a visit compared to insured patients.
There are plausible reasons for uninsured patients
Acknowledgments
We are grateful to OCHIN, Inc., and the participating clinics for making this research possible. We would like to acknowledge Carrie Tillotson, MPH, for her assistance with the production of Figure 1.
This study was supported by grant No. R01HL107647 from the National Heart, Lung, and Blood Institute and grant No. K08HS021522 from the Agency for Healthcare Research and Quality.
The study sponsor had no role in study design; collection, analysis, or interpretation of data; writing the report; or
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