School of Pharmacy, University of Wisconsin-Madison, Wisconsin, United States.
Res Social Adm Pharm. 2013 Nov-Dec;9(6):790-6. doi: 10.1016/j.sapharm.2012.11.005. Epub 2012 Dec 13.
Diabetes has long been a leading cause of death in the United States, and worldwide. Diabetes-related preventive services are recommended to delay or to avoid diabetes complications. Racial disparity in the receipt of diabetes preventive care is well documented; however, little is known about the contributors to this disparity.
This study aims to explore potential mediators linking race/ethnic disparities to reduced receipt of preventive care, and to better understand the dynamics underlying the relationships between race/ethnic characteristics and preventive care. Implications for pharmacist roles are explored.
This study used 2008 Medical Expenditure Panel Survey (MEPS) data. The outcome of diabetes preventive care was assessed by participants' self-reports in MEPS. Household income and health insurance coverage were identified as potential mediators based on Andersen's Health Care Utilization Behavior model. Logistic regression was used to examine the direct effects of study independent variables on diabetes preventive care. Path analysis was conducted to identify racial disparities' direct and indirect effects on diabetes preventive care via potential mediators. All estimates were weighted to the U.S. non-institutionalized population.
Racial differences occurred with respect to receiving A1C tests, diabetic foot exams, and eye exams. After controlling for patient age, gender, living area, income, and health insurance status, racial differences persisted in diabetes preventive care. Hispanics were the least likely to receive all three elements of diabetes preventive care. In addition, patients were less likely to receive diabetes preventive care who were younger, lived in rural areas, had lower family income and were uninsured. A lower rate of diabetes preventive care in minority patients was partially explained by their higher rate of being uninsured or having low family income.
The results suggest that minority, rural, low-income, uninsured, and young diabetes patients are at a higher risk of not receiving diabetes preventive care. This study is unique in its use of path analysis to assess racial disparities in diabetes preventive care and to do so drawing on Andersen's Health Care Utilization Behavior model. In response to the disparity findings which were reinforced in this study, pharmacists have a need and an opportunity to help identify and address important gaps in diabetes preventive care through diabetes patient assessment, education, referral, and monitoring.
糖尿病一直是美国乃至全球的主要死亡原因之一。建议提供与糖尿病相关的预防服务，以延缓或避免糖尿病并发症。种族差异导致接受糖尿病预防护理的情况存在很大差异，这一点已有充分记录；然而，对于导致这种差异的因素知之甚少。
本研究旨在探讨将种族/民族差异与预防护理减少联系起来的潜在中介因素，并更好地理解种族/民族特征与预防护理之间关系的动态。探讨了药剂师角色的影响。
本研究使用了 2008 年医疗支出面板调查（MEPS）数据。通过 MEPS 中参与者的自我报告评估糖尿病预防护理的结果。根据安德森的医疗保健利用行为模型，将家庭收入和医疗保险覆盖范围确定为潜在的中介因素。使用逻辑回归检验研究独立变量对糖尿病预防护理的直接影响。通过潜在中介因素，进行路径分析以确定种族差异对糖尿病预防护理的直接和间接影响。所有估计值均按美国非机构化人口进行加权。
在接受 A1C 测试、糖尿病足检查和眼部检查方面存在种族差异。在控制了患者年龄、性别、居住区域、收入和医疗保险状况后，种族差异在糖尿病预防护理方面仍然存在。西班牙裔接受所有三种糖尿病预防护理的可能性最小。此外，年龄较小、居住在农村地区、家庭收入较低和没有保险的患者接受糖尿病预防护理的可能性较低。少数民族患者接受糖尿病预防护理的比率较低，部分原因是他们没有保险或家庭收入较低的比率较高。
结果表明，少数民族、农村、低收入、没有保险和年轻的糖尿病患者接受糖尿病预防护理的风险更高。本研究的独特之处在于使用路径分析评估糖尿病预防护理方面的种族差异，并借鉴安德森的医疗保健利用行为模型进行评估。在这项研究中，发现了差异，并得到了加强，药剂师有必要和机会通过糖尿病患者评估、教育、转介和监测来帮助识别和解决糖尿病预防护理方面的重要差距。
