Department of Pharmacotherapy, University of Utah, 421 Wakara Way, Rm 208, Salt Lake City, UT 84108, USA.
Am J Manag Care. 2010 Jan;16(1):55-64.
To evaluate the relationship between insurance type (Medicaid vs private insurance) and access to physician care for youth with type 2 diabetes mellitus by quantifying whether these youth saw a physician during the year before their first diabetes documentation.
Retrospective cohort study.
Youth with Medicaid or private insurance aged 5 to 19 years with type 2 diabetes were identified by an electronic medical record review. The first indication of type 2 diabetes defined the index date. Youth with type 1 diabetes and female patients with polycystic ovaries were excluded. Descriptive statistics evaluated differences in office visits before the index date between patients with the 2 insurance types. Multivariate logistic regression analysis evaluated the likelihood of having an office visit during the year before the index date among youth with Medicaid versus private insurance, controlling for youth characteristics.
Of 2496 included youth, 400 (16.0%) had Medicaid coverage. More than 60% were female, the mean age was 14.5 years, and 68.8% were obese. On average, youth had 1.9 office visits during the year before the index date. Medicaid-covered youth were not significantly less likely to have had an office visit (odds ratio, 0.77; P = .09) or fewer total office visits (incident rate ratio, 1.13; P = .16) during the year before the index date.
The likelihood of youth with type 2 diabetes and a source of physician care having a physician office visit during the year before the index date did not differ between patients with Medicaid versus private insurance. This suggests that the amount of physician care before diagnosis of type 2 diabetes does not differ for Medicaid-covered youth if they can establish a source of care. Additional research is investigating whether physician access before diagnosis is associated with access to diabetes-related care after diagnosis.
通过量化患有 2 型糖尿病的青年在首次糖尿病记录前一年就诊医生的情况，评估保险类型（医疗补助与私人保险）与青年获得医生治疗的关系。
回顾性队列研究。
通过电子病历审查，确定患有 2 型糖尿病且年龄在 5 至 19 岁的青年，将其医疗补助或私人保险作为分类变量。首次 2 型糖尿病的诊断定义为索引日期。排除患有 1 型糖尿病的青年和患有多囊卵巢的女性患者。在索引日期前，通过描述性统计评估 2 种保险类型患者的就诊次数差异。通过多变量逻辑回归分析，控制青年特征，评估医疗补助与私人保险的青年在索引日期前一年就诊的可能性。
在纳入的 2496 名青年中，有 400 名（16.0%）有医疗补助。超过 60%为女性，平均年龄为 14.5 岁，68.8%为肥胖。平均而言，青年在索引日期前一年有 1.9 次就诊。医疗补助覆盖的青年在索引日期前一年就诊（优势比，0.77；P =.09）或就诊次数更少（发生率比，1.13；P =.16）的可能性并不显著较低。
患有 2 型糖尿病且有医生就诊渠道的青年在索引日期前一年有医生就诊的可能性，在医疗补助与私人保险患者之间无差异。这表明，如果患有 2 型糖尿病的青年能够建立就诊渠道，那么在确诊前接受的医生护理量就不会因是否获得医疗补助而有所不同。进一步的研究正在调查诊断前的医生就诊机会是否与诊断后获得糖尿病相关护理的机会相关。
