235061 Preventive care for diabetes in older U.S. populations

Wednesday, November 2, 2011: 8:35 AM

Xiaoxing He, MD, MPH , Health Sciences, Cleveland State University, Cleveland, OH
Objective: To investigate the degree of preventive care and predictors of preventive services for patients with diabetes aged 65 years and older.

Methods: Cross-sectional study of a nationally-representative sample of 16,419 ambulatory care visits by older Americans, using data from the 2006 and 2007 National Ambulatory Medical Care Surveys (NAMCS). The outcome variables are whether any preventive care services, defined as diagnostic testing (glucose, hemoglobinA1c, blood pressure, and cholesterol) or patient education (diet/nutrition and exercise), were ordered/provided. Multivariate analysis was performed to identify independent predictors of diabetes preventive care, controlling for patient and physician practice characteristics. All analyses were adjusted for the complex survey design.

Results: Compared to people without diabetes, older patients with diabetes were more likely to be African or Hispanic American; and covered by Medicaid (9.0% vs. 5.3%). In multivariate analyses, having a primary care physician, and the availability of electronic medical record or on-site laboratory testing were associated with more effective preventive care services (p<0.05). If physician compensation relied on the productivity, preventive care services were less likely (odds ratio = 0.5). The patterns of patient education and diagnostic testing were similar (odds ratio = 2.5 and 18.2 for older men; odds ratio =1.8 and 9.6 for older women), but patient education was less likely.

Conclusions: A designated primary care physician is crucial for providing recommended preventive care in older patients with diabetes. Strategies to strengthen structural capabilities of primary care practices are necessary in order to meet the needs of diabetes care management for older U.S. populations.

Learning Areas:
Chronic disease management and prevention
Public health or related education

Learning Objectives:
Identify the degree of preventive care and predictors of preventive services for patients with diabetes aged 65 years and older

Keywords: Diabetes, Preventive Medicine

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am an assistant professor of health sciences at the Cleveland State University, with professional experience as a physician, health promotion practitioner, health services researcher, and teacher in health sciences and health care studies.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

See more of: Diabetes epidemiology
See more of: Epidemiology