Mainous A G, Gill J M
Department of Family Medicine, Medical University of South Carolina, Charleston 29425, USA.
Fam Med. 2001 Feb;33(2):115-9.
We examined the performance of screening tests for diabetic nephropathy in a population of privately insured individuals.
Administrative data from a large private health plan were analyzed. Continuously insured persons with diabetes (ages 30-62) with > or = one office visit during the study year (July 1995 to June 1996) were included (n = 4,758). Outcome variables included a urinalysis for protein and a test for microalbuminuria. The likelihood of test performance according to age, gender, insurance plan type, total office visits, diabetes office visits, and specialty of predominant physician was examined both in bivariate analyses and a logistic regression.
Among the 4,623 patients without evidence of nephropathy, only 16.5% had a urinalysis test conducted sometime in the year. All individuals (2.1% of sample) who received a microalbuminuria test also received a urinalysis. Individuals with indemnity or PPO plans were more likely to be screened than individuals in point-of-service plans. Patients with more visits and more diabetes visits were more likely to be screened. In the regression with family practice as the reference category, general internists were the only physician specialty more likely to have screened patients.
The majority of patients with diabetes mellitus do not receive annual screening for microalbuminuria or urinary protein.
我们在一个参加私人保险的人群中检验了糖尿病肾病筛查试验的性能。
分析了来自一个大型私人健康计划的管理数据。纳入了在研究年度（1995年7月至1996年6月）期间持续参保且患有糖尿病（年龄30 - 62岁）且进行过≥1次门诊就诊的人员（n = 4758）。结局变量包括尿蛋白分析和微量白蛋白尿检测。在双变量分析和逻辑回归中均检验了根据年龄、性别、保险计划类型、门诊就诊总数、糖尿病门诊就诊次数以及主要医生专业进行检测的可能性。
在4623例无肾病证据的患者中，仅16.5%在该年度的某个时间进行了尿蛋白分析检测。所有接受微量白蛋白尿检测的个体（占样本的2.1%）也都进行了尿蛋白分析检测。参加赔偿型或优先提供者组织（PPO）计划的个体比参加服务点（POS）计划的个体更有可能接受筛查。就诊次数更多以及糖尿病门诊就诊次数更多的患者更有可能接受筛查。在以家庭医疗作为参照类别进行的回归分析中，普通内科医生是唯一更有可能为患者进行筛查的医生专业。
大多数糖尿病患者未接受微量白蛋白尿或尿蛋白的年度筛查。
