Preventive care for diabetes in older U.S. populations

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.