Use of preventive services for diabetes patients and policy implication: A national study

Objective: To identify whether patient and practice characteristics predict the likelihood of preventive services use at physician office visits for patients with diabetes.

Methods: This study used a cross-sectional design and data from 2005-2007 NAMCS. The outcome variable is whether any preventive services, defined as either diagnostic/screening services (CBC, blood pressure, glucose, HgbA1c, and cholesterol) or health education (diet/nutrition, exercise, stress management, and weight reduction), were provided or ordered. Multivariate analysis was performed to identify independent predictors of the diagnostic and counseling services, controlling for patient and practice characteristics. All analyses were adjusted for the complex survey design.

Results: Compared to people without diabetes, diabetes patients were older (63y vs. 53y), more likely to be minorities, and reside in rural areas (15% vs. 14%). In multivariate analysis, younger age, Hispanics, being new patient, living in urban area, and having other chronic diseases (i.e., CHF, hypertension, and obesity), being seen by primary care physicians or nurses were associated with higher likelihood of preventive services (p<0.05). The patterns of the use of diagnostic/screening and health education services were similar, but the likelihood of health education was lower than diagnostic/screening services at practice setting of health center (odds ratio 0.9 vs. 2.2).

Conclusions: Health insurance did not seem to have significant impact on the use of preventive services while primary care physicians were more likely to provide preventive services. Given the time-constraint of physicians, strategies to enhance public health system's ability to promote diabetes prevention and to increase diabetes health education are recommended.