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APHA Scientific Session and Event Listing

Recorded presentation

Samuel N. Forjuoh, MD, DrPH¹, Michael D. Reis, MD¹, Marcia G. Ory, PhD, MPH², Glen R. Couchman, MD¹, and R. Marc Via, MD¹. (1) Department of Family & Community Medicine, Scott & White, Texas A&M College of Medicine, Scott & White Santa Fe - Century Square, 1402 West Ave H, Temple, TX 76504-5342, 254-771-7695, sforjuoh@swmail.sw.org, (2) School of Rural Public Health, Department of Social and Behavioral Health, TAMU 1266, College Station, TX 77843-1266

CONTEXT: Primary care physicians' (PCPs) referral patterns of patients with diabetes for specialty care is understudied. OBJECTIVE: To describe and characterize specialty care referrals for adult patients with diabetes by PCPs, with a particular focus on examining some of the socio-demographic correlates of referrals to cardiology, endocrinology, ophthalmology/optometry, and podiatry. Our goal was to describe the ways in which patients referred to cardiology, for example, differ from those referred to podiatry in terms of the socio-demographic characteristics contained in our organization's linked dataset. METHODS: We conducted a cross-sectional analysis of administrative data from 15 primary care clinics of a large university-affiliated, multi-specialty group practice associated with an 186,000-member HMO, the Scott & White Health Plan (SWHP). Participants were patients aged 18 years or older seen by a PCP between June 1, 2003 and May 31, 2004 and assigned an ICD-9 code 250.XX, indicative of diabetes. We assessed significant differences between groups using two-tailed chi-square or Fisher's exact tests for categorical data and t-test for continuous data at the P<.05 significance level. Multiple logistic regressions were modeled to determine significant correlates of referrals for specialty care and to estimate adjusted odds ratios (OR) and 95% confidence intervals (95% CI). RESULTS: A total of 3,462 patients were seen by PCPs for diabetes over the one-year study period. Patients' mean age was 60 years (SD=14; range 19-97). The majority was female (55.4%) and white (57%); 48.4% were married. The vast majority (70.2%) was seen at two of the 15 clinics of the organization. Of the total patients, 84.8% had at least one referral for specialist care, mostly to ophthalmology/optometry (24.8%), cardiology (13.3%), podiatry (11.6%), and endocrinology (8.0%). Patient age group (P<.004), gender (P=.0001), ethnicity (P<.0001), and insurance type (P<.0001) had significant associations with the type of specialty care referral offered after multivariate adjustment. Patients with Seniorcare (Medicare plus SWHP) were three times as likely to be referred as those with only SWHP (adjusted OR=2.95, 95% CI=1.92-4.53). Different patient profiles were also seen by provider specialty (e.g., specialist care referrals to cardiology were significantly higher for older, white, male patients). CONCLUSIONS: Adult patients with diabetes referred for specialty care by PCPs present different profiles by provider specialty, an important consideration for providing better care. The variation in specialty care referrals by PCPs may reflect their inadequate adherence to disease management guidelines, suggesting a need for periodical review of their referral process.

Learning Objectives: At the conclusion of the session, the participant will be able to

• Recognize the referral patterns of primary care physicians for diabetes care.
• Describe the variation in specialty care referrals among primary care physicians.
• Identify the characteristics of patients with diabetes referred for specialty care by provider specialty.

Keywords: Diabetes, Primary Care

Presenting author's disclosure statement:

Any relevant financial relationships? No

Recorded presentation