Njeru Jane W, Boehm Deborah H, Jacobson Debra J, Guzman-Corrales Laura M, Fan Chun, Shimotsu Scott, Wieland Mark L
Division of Primary Care Internal Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Hennepin County Medical Center, Minneapolis Medical Research Foundation, Minneapolis, MN, USA.
J Community Health. 2017 Aug;42(4):819-825. doi: 10.1007/s10900-017-0323-x.
Immigrants and refugees are less likely to meet diabetes management goals than the general US population. Those with limited English proficiency (LEP) and who need interpreter services (IS) for health care encounters, maybe at higher risk for encountering barriers to optimal diabetes management, and while most receive diabetes care in primary care settings, little is known about the association between IS need and diabetes outcomes. This study aims to determine adherence with diabetes process and outcomes measures among LEP patients in primary care settings, and is a retrospective cohort study of patients with type II diabetes at two large primary care networks in Minnesota from January 1, 2012 through December 31, 2013. Diabetes outcome measure goals were defined as hemoglobin A1C <8%, LDL-C <100 mg/dL, and blood pressure <140/90 mmHg. Process measure goals were defined as hemoglobin A1C measured within the previous 6 months and LDL cholesterol (LDL-C) measured within the previous 12 months. Compared to non-IS patients (N = 11,970), IS patients (N = 1486) were more likely to meet guideline outcome recommendations for blood pressure (Adjusted odds ratio [OR] 2.02; 95% confidence interval [CI] 1.70, 2.40), hemoglobin A1C (OR 1.23; 95% CI 1.08, 1.40), and LDL-C (OR 1.40; 95% CI 1.2, 1.62). Older IS patients and male IS patients were less likely to meet recommendations for hemoglobin A1C (OR 0.70; 95% CI 0.48, 1.02; OR 0.66; CI 0.54, 0.79; respectively) and LDL-C (OR 0.81; 95% CI 0.55, 1.17; OR 0.47; CI 0.39, 0.57; respectively). Healthcare system solutions need to bridge gaps from process to outcomes among LEP patients who require IS in primary care settings.
与美国普通人群相比，移民和难民实现糖尿病管理目标的可能性较小。那些英语水平有限（LEP）且在医疗保健过程中需要口译服务（IS）的人，在实现最佳糖尿病管理方面可能面临更高的障碍风险。虽然大多数人在初级保健机构接受糖尿病护理，但对于IS需求与糖尿病治疗结果之间的关联却知之甚少。本研究旨在确定初级保健机构中LEP患者对糖尿病治疗过程和治疗结果指标的依从性，是一项对明尼苏达州两个大型初级保健网络中2012年1月1日至2013年12月31日期间的II型糖尿病患者进行的回顾性队列研究。糖尿病治疗结果指标目标定义为糖化血红蛋白A1C<8%、低密度脂蛋白胆固醇（LDL-C）<100mg/dL和血压<140/90mmHg。治疗过程指标目标定义为在前6个月内测量糖化血红蛋白A1C，在前12个月内测量低密度脂蛋白胆固醇（LDL-C）。与非IS患者（N = 11970）相比，IS患者（N = 1486）更有可能达到血压（调整后的优势比[OR] 2.02；95%置信区间[CI] 1.70，2.40）、糖化血红蛋白A1C（OR 1.23；95%CI 1.08，1.40）和LDL-C（OR 1.40；95%CI 1.2，1.62）的指南治疗结果建议。年龄较大的IS患者和男性IS患者达到糖化血红蛋白A1C（分别为OR 0.70；95%CI 0.48，1.02；OR 0.66；CI 0.54，0.79）和LDL-C（分别为OR 0.81；95%CI 0.55，1.17；OR 0.47；CI 0.39，0.57）建议的可能性较小。医疗保健系统解决方案需要弥合初级保健机构中需要IS的LEP患者从治疗过程到治疗结果的差距。
