Bell Ronny A, Quandt Sara A, Arcury Thomas A, Snively Beverly M, Stafford Jeanette M, Smith Shannon L, Skelly Anne H
Department of Public Health Sciences, Wake Forest University School of Medicine, Winston-Salem, NC 27157-1063, USA.
J Rural Health. 2005 Summer;21(3):198-205. doi: 10.1111/j.1748-0361.2005.tb00083.x.
Residents in rural communities in the United States, especially ethnic minority group members, have limited access to primary and specialty health care that is critical for diabetes management. This study examines primary and specialty medical care utilization among a rural, ethnically diverse, older adult population with diabetes.
Data were drawn from a cross-sectional face-to-face survey of randomly selected African American (n=220), Native American (n=181), and white (n=297) Medicare beneficiaries > or =65 years old with diabetes in 2 rural counties in central North Carolina. Participants were asked about utilization of a primary care doctor and of specialists (nutritionist, diabetes specialist, eye doctor, bladder specialist, kidney specialist, heart specialist, foot specialist) in the past year.
Virtually all respondents (99.0%) reported having a primary care doctor and seeing that doctor in the past year. About 42% reported seeing a doctor for diabetes-related care. On average, participants reported seeing 2 specialists in the past year, and 54% reported i seeing >1 specialist. Few reported seeing a diabetes specialist (5.7%), nutritionist (10.9%), or kidney specialist (17.5%). African Americans were more likely than others to report seeing a foot specialist (P < .01), while men were more likely than women to have seen bladder specialist (P = .02), kidney specialist (P = .001), and heart specialist (P = .004), after adjusting for potential confounders. Predictors of the number of specialists seen include gender, education, poverty status, diabetes medication use, and self-rated health.
These data indicate low utilization of specialty diabetes care providers across ethnic groups and reflect the importance of primary care providers in diabetes care in rural areas.
美国农村社区居民，尤其是少数族裔成员，获得对糖尿病管理至关重要的初级和专科医疗服务的机会有限。本研究调查了农村地区、种族多样的老年糖尿病患者群体的初级和专科医疗服务利用情况。
数据来自对北卡罗来纳州中部两个农村县随机抽取的220名非裔美国人、181名美国原住民和297名65岁及以上患有糖尿病的白人医疗保险受益人的横断面面对面调查。参与者被问及过去一年中初级保健医生和专科医生（营养师、糖尿病专科医生、眼科医生、膀胱专科医生、肾脏专科医生、心脏专科医生、足部专科医生）的就诊情况。
几乎所有受访者（99.0%）报告在过去一年中有初级保健医生并看过该医生。约42%的人报告因糖尿病相关护理看过医生。参与者平均报告在过去一年中看过2名专科医生，54%的人报告看过1名以上专科医生。很少有人报告看过糖尿病专科医生（5.7%）、营养师（10.9%）或肾脏专科医生（17.5%）。在调整潜在混杂因素后，非裔美国人比其他人更有可能报告看过足部专科医生（P < .01），而男性比女性更有可能看过膀胱专科医生（P = .02）、肾脏专科医生（P = .001）和心脏专科医生（P = .004）。看过专科医生数量的预测因素包括性别、教育程度、贫困状况、糖尿病药物使用情况和自我评估的健康状况。
这些数据表明各民族对糖尿病专科护理提供者的利用率较低，并反映了初级保健提供者在农村地区糖尿病护理中的重要性。
