低收入老年患者是否面临糖尿病护理不佳的风险？

Are low-income elderly patients at risk for poor diabetes care?

作者信息

McCall Daniel T, Sauaia Angela, Hamman Richard F, Reusch Jane E, Barton Phoebe

机构信息

Colorado Foundation for Medical Care, Denver, Colorado, USA.

出版信息

Diabetes Care. 2004 May;27(5):1060-5. doi: 10.2337/diacare.27.5.1060.

DOI:10.2337/diacare.27.5.1060

PMID:15111521

Abstract

OBJECTIVE

Diabetes is common among low-income elderly, dual-eligible (DE) Medicare/Medicaid patients resulting in significant morbidity, mortality, and cost. However, the quality of diabetes care delivered to these patients has not been evaluated. The aims of this study were to describe the quality of diabetes care provided to DE patients and compare it with non-DE patients.

RESEARCH DESIGN AND METHODS

This was a cross-sectional analysis of administrative claims from 1 January 1997 through 31 December 1998. A total of 9,453 patients aged 65-75 years with diabetes participated in the study. These were Colorado Medicare fee-for-service (FFS) outpatients. The main outcome measures consisted of a proportion of patients receiving an annual hemoglobin A1c test, biennial eye examination, biennial lipid test, and all three of these care processes.

RESULTS

The mean patient age was 71 +/- 2.8 years. Over 22% of patients were identified as dual eligible, and they were significantly more likely to be younger, female, and of minority race/ethnicity; reside in a rural location; and have comorbid conditions compared with the non-DE population. DE patients had more visits to primary care physicians, emergency departments, and hospitalizations but were less likely to visit endocrinologists. DE patients were significantly less likely to receive an annual A1c test (73 vs. 81%; P < 0.0001), biennial ophthalmologic examination (63 vs. 75%; P < 0.0001), and biennial lipid testing (43 vs. 57%; P < 0.0001). The adjusted odds ratio of urban DE patients receiving all three care measures was 0.60 (95% CI 0.52-0.69) compared with urban non-DE patients. Minority race/ethnicity and emergency department use were significantly associated with not receiving diabetes care, whereas endocrinology visits were associated with an increased odds of receiving diabetes care.

CONCLUSIONS

DE Medicare/Medicaid status was independently associated with not receiving diabetes care, especially among those in urban areas.

摘要

目的

糖尿病在低收入老年人、符合双重资格（DE）的医疗保险/医疗补助患者中很常见，会导致严重的发病率、死亡率和成本。然而，为这些患者提供的糖尿病护理质量尚未得到评估。本研究的目的是描述为DE患者提供的糖尿病护理质量，并将其与非DE患者进行比较。

研究设计与方法

这是一项对1997年1月1日至1998年12月31日行政索赔数据的横断面分析。共有9453名年龄在65 - 75岁的糖尿病患者参与了该研究。这些是科罗拉多州医疗保险按服务收费（FFS）的门诊患者。主要结局指标包括接受年度糖化血红蛋白（A1c）检测、每两年一次眼科检查、每两年一次血脂检测的患者比例，以及接受所有这三项护理流程的患者比例。

结果

患者平均年龄为71±2.8岁。超过22%的患者被确定为符合双重资格，与非DE人群相比，他们更有可能年龄较小、为女性、属于少数种族/族裔；居住在农村地区；并且患有合并症。DE患者看初级保健医生、急诊科的次数更多，住院次数也更多，但看内分泌科医生的可能性较小。DE患者接受年度A1c检测（73%对81%；P<0.0001）、每两年一次眼科检查（63%对75%；P<0.0001）和每两年一次血脂检测（43%对57%；P<0.0001）的可能性显著更低。与城市非DE患者相比，城市DE患者接受所有三项护理措施的调整后比值比为0.60（95%CI 0.52 - 0.69）。少数种族/族裔和去急诊科就诊与未接受糖尿病护理显著相关，而看内分泌科与接受糖尿病护理的几率增加相关。