Jones Laura E, Clarke William, Carney Caroline P
Department of Epidemiology, The University of Iowa College of Medicine, Iowa City, Iowa, USA.
Med Care. 2004 Dec;42(12):1167-75. doi: 10.1097/00005650-200412000-00003.
We sought to determine whether receipt of the American Diabetes Association's recommended clinical services was similar among insured subjects with and without mental disorders during the period of 1996 to 2001.
Our study was a retrospective analysis of Blue Cross/Blue Shield of Iowa administrative claims data, 1996-2001.
We studied 26,020 adults with diabetes; 6,627 (25%) had a coexisting mental disorder.
Service receipt included hemoglobin A1c (HbA1c) testing, dilated eye examination, cholesterol measurement, and urine protein testing. We used Cox regression to calculate hazard ratios (HRs) for service receipt after adjusting for demographic, disease, and utilization factors.
Mental disorder subjects were more likely to be younger, women, urban residents, have diabetes complications and comorbidity, and to have increased healthcare utilization. Although they received more services (mean, 2.6) than subjects without mental disorders (mean, 2.3), they were less likely to have received a HbA1c test (HR 0.92; 99.9% confidence interval [CI] 0.87-0.97) and a cholesterol measurement (HR 0.92; 99.9% CI 0.86-0.98). Receipt of a dilated eye examination (HR 0.96; 99.9% CI 0.89-1.04) and urine protein test (HR 0.98; 99.9% CI 0.92-1.04) was similar. Service receipt varied by specific mental disorder categorization. Few subjects (< 6%) strictly adhered to the guidelines of the American Diabetes Association.
Receipt of clinical preventive services for both populations was suboptimal. Importantly, subjects with mental disorders were more likely to have diabetic complications, even when controlling for utilization of healthcare services, possibly because of poorer receipt of HbA1c testing. Persons with mental disorders should be more aggressively educated about blood sugar control, given the high rate of complications in this population. Medical care directed at persons with comorbid medical and psychiatric disorders may be beneficial.
我们试图确定在1996年至2001年期间，患有和未患有精神障碍的参保受试者接受美国糖尿病协会推荐的临床服务的情况是否相似。
我们的研究是对1996 - 2001年爱荷华州蓝十字/蓝盾保险公司行政索赔数据的回顾性分析。
我们研究了26,020名成年糖尿病患者；其中6,627名（25%）同时患有精神障碍。
服务接受情况包括糖化血红蛋白（HbA1c）检测、散瞳眼底检查、胆固醇测量和尿蛋白检测。我们使用Cox回归在调整了人口统计学、疾病和使用因素后计算服务接受的风险比（HRs）。
患有精神障碍的受试者更可能较年轻、为女性、居住在城市、患有糖尿病并发症和合并症，且医疗服务利用率更高。尽管他们比未患有精神障碍的受试者接受了更多的服务（平均2.6项），但他们接受HbA1c检测（HR 0.92；99.9%置信区间[CI] 0.87 - 0.97）和胆固醇测量（HR 0.92；99.9% CI 0.86 - 0.98）的可能性更低。接受散瞳眼底检查（HR 0.96；99.9% CI 0.89 - 1.04）和尿蛋白检测（HR 0.98；99.9% CI 0.92 - 1.04）的情况相似。服务接受情况因特定的精神障碍分类而异。很少有受试者（<6%）严格遵循美国糖尿病协会的指南。
这两类人群的临床预防服务接受情况都不理想。重要的是，即使在控制了医疗服务利用率之后，患有精神障碍的受试者更有可能患有糖尿病并发症，这可能是因为HbA1c检测的接受情况较差。鉴于该人群并发症发生率较高，应对患有精神障碍的人进行更积极的血糖控制教育。针对患有合并医疗和精神疾病的人的医疗护理可能会有益处。
