Quality of Preventive Care for Diabetes: Effects of Visit Frequency and Competing Demands
Open accessAbstract
PURPOSE: We sought to determine the association between timely receipt of diabetes-related preventive services and the longitudinal pattern of outpatient service use as characterized by a novel taxonomy that prioritized visits based on the Oregon State Prioritized Health Services List. METHODS: We performed a cross-sectional analysis of mail survey and automated health care data for a population-based sample of patients with diabetes enrolled in a health maintenance organization in Washington State (N = 4,463). Outcomes included American Diabetes Association-recommended preventive services, including regular hemoglobin A1C (HbA1C) monitoring, retinal examination, and microalbuminuria screening. Patients with fewer than 8 visits during the 2-year study period were considered infrequent users, while patients with 8 or more visits were classified as lower-priority users if most visits were for conditions of relatively low rank on the Oregon list and as higher-priority users otherwise. RESULTS: After adjustment for social, demographic, and clinical factors, and depression, infrequent users had significantly reduced odds of receiving at least 1 HbA1C test (odds ratio [OR] = 0.35, 95% confidence interval [CI], 0.24-0.51), retinal examination (OR = 0.74, 95% CI, 0.63-0.86), and microalbuminuria screening (OR = 0.75, 95% CI, 0.58-0.96) relative to higher-priority users during the previous year. Lower-priority users also had relatively reduced odds of receiving at least 1 HbA(1C) test (OR = 0.59, 95% CI, 0.35-1.01), retinal examination (OR = 0.68, 95% CI, 0.56-0.84), and microalbuminuria screening (OR = 0.79, 95% CI, 0.57-1.09) despite attending a similar mean number of total visits as higher-priority users. CONCLUSIONS: Patients who attend relatively few outpatient visits or who attend more frequent visits for predominantly lower-priority conditions are more likely to receive substandard preventive care for diabetes.
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Low quality of care may increase the risk of type 2 diabetes mellitus patients receiving suboptimal preventive care for their diabetes.
“It may increase the risk of those patients receiving suboptimal preventive care for their diabetes [45,46].”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [46]
The Discussion reports that patients with infrequent visits or visits predominantly for lower-priority conditions were more likely to miss timely diabetes preventive services. It does not identify low quality of care itself as a factor that increases the risk of receiving suboptimal preventive care. (LLM, conf=0.80)
Experimental — accuracy not yet measuredLow quality of care may result in visit-to-visit HbA1c variability among type 2 diabetes mellitus patients and relatively fewer outpatient visits.
“Low quality of care may result in visit-to-visit HbA1c variability among T2DM patients and relatively fewer outpatient visits.”
From Clinical Inertia in the Management of Type 2 Diabetes Mellitus: A Systematic Review (2023) · cites this paper as [46]
The Discussion (page unavailable) reports that patients with infrequent outpatient visits were less likely to receive timely diabetes preventive care. The paper measures receipt of HbA1c tests, not visit-to-visit HbA1c variability, and does not establish that low-quality care causes fewer visits; it examines visit patterns as predictors of preventive care. (LLM, conf=0.86)
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References 30 · Cited by 89
Research works printed but not linked: 23
- Vijan S, Stevens DL, Herman WH, Funnell MM, Standiford CJ. Screening, prevention, counseling, and treatment for the complica- tions of type II diabetes mellitus: putting evidence into practice. J Gen Intern Med. 1997;12:567-580.
- Beckles GL, Engelgau MM, Narayan KM, et al. Population-based assessment of the level of care among adults with diabetes in the U.S. Diabetes Care. 1998;21:1432-1438.
- Streja DA, Rabkin SW. Factors associated with implementation of pre- ventive care measures in patients with diabetes mellitus. Arch Intern Med. 1999;159:294-302.
- Hippisley-Cox J, Pringle M. Prevalence, care, and outcomes for patients with diet-controlled diabetes in general practice: cross sec- tional survey. Lancet. 2004;364:423-428.
- Redelmeier DA, Tan SH, Booth GL. The treatment of unrelated disorders in patients with chronic medical diseases. N Engl J Med. 1998;338:1516-1520.
- Kiefe CI, Funkhouser E, Fouad MN, May DS. Chronic disease as a barrier to breast and cervical cancer screening. J Gen Intern Med. 1998;13:357-365.
- Nutting PA, Baier M, Werner JJ, et al. Competing demands in the offi ce visit: what infl uences mammography recommendations? J Am Board Fam Pract. 2001;14:352-361.
- Yawn B, Goodwin MA, Zyzanski SJ, Stange KC. Time use during acute and chronic illness visits to a family physician. Fam Pract. 2003;20:474-477.
- Katon W, von Korff M, Ciechanowski P, et al. Behavioral and clinical factors associated with depression among individuals with diabetes. Diabetes Care. 2004;27:914-920.
- McCulloch DK, Price MJ, Hindmarsh M, Wagner EH. A population- based approach to diabetes management in a primary care setting: early results and lessons learned. Eff Clin Pract. 1998;1:12-22.
- Bodenheimer T. The Oregon Health Plan-lessons for the nation. First of two parts. N Engl J Med. 1997;337:651-655.
- Rosenzweig JL, Weinger K, Poirier-Solomon L, Rushton M. Use of a disease severity index for evaluation of healthcare costs and manage- ment of comorbidities of patients with diabetes mellitus. Am J Manag Care. 2002;8:950-958.
- Fishman PA, Goodman MJ, Hornbrook MC, et al. Risk adjustment using automated ambulatory pharmacy data: the RxRisk model. Med Care. 2003;41:84-99.
- Rao RS, Sigurdson AJ, Doody MM, Graubard BI. An application of a weighting method to adjust for nonresponse in standardized incidence ratio analysis of cohort studies. Ann Epidemiol. 2005;15:129-136.
- Harris MI. Health care and health status and outcomes for patients with type 2 diabetes. Diabetes Care. 2000;23:754-758.
- Jaen CR, Stange KC, Nutting PA. Competing demands of primary care: a model for the delivery of clinical preventive services. J Fam Pract. 1994;38:166-171.
- Chernof BA, Sherman SE, Lanto AB, et al. Health habit counseling amidst competing demands: effects of patient health habits and visit characteristics. Med Care. 1999;37:738-747.
- Stange KC, Flocke SA, Goodwin MA, Kelly RB, Zyzanski SJ. Direct observation of rates of preventive service delivery in community fam- ily practice. Prev Med. 2000;31:167-176.
- Nutting PA, Rost K, Smith J, Werner JJ, Elliot C. Competing demands from physical problems: effect on initiating and completing depres- sion care over 6 months. Arch Fam Med. 2000;9:1059-1064.
- Beck A, Scott J, Williams P, et al. A randomized trial of group outpa- tient visits for chronically ill older HMO members: the Cooperative Health Care Clinic. J Am Geriatr Soc. 1997;45:543-549.
- Wagner EH, Grothaus LC, Sandhu N, et al. Chronic care clinics for diabetes in primary care: a system-wide randomized trial. Diabetes Care. 2001;24:695-700.
- Kravitz RL, Bell RA, Azari R, et al. Direct observation of requests for clinical services in offi ce practice: what do patients want and do they get it? Arch Intern Med. 2003;163:1673-1681.
- Kravitz RL, Epstein RM, Feldman MD, et al. Infl uence of patients' requests for direct-to-consumer advertised antidepressants: a random- ized controlled trial. JAMA. 2005;293:1995-2002.
- Authors
- Fenton, J. J.
- Affiliations
- University of California Davis Medical Center (US)
- Corresponding author
- Fenton, J. J.
- ORCID
- Fenton, J. J.
- Venue
- The Annals of Family Medicine
- Publisher
- Annals of Family Medicine
- Published
- 2006-01-01
- Volume
- 4
- Issue
- 1
- Pages
- 32-39
- ISSN
- 1544-1709 (ISSN-L)
- 1544-1717
- PMC
- PMC1466990
- OpenAlex
- W2156860146
- Cited by
- 89
- References
- 30
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 5 · 2023: 3 · 2022: 3 · 2021: 9 · 2020: 5 · 2019: 3 · 2018: 1 · 2017: 3 · 2016: 3 · 2015: 5 · 2014: 5 · 2013: 7 · 2012: 7
- FWCI
- 3.64
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Locations
- The Annals of Family Medicine (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Funders
- National Institute of Mental Health (R01MH041739, MH01643, MH4-1739, K02MH001643)
- Topics
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Diabetes Management and Education
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Health Promotion and Cardiovascular Prevention
- Health Sciences › Health Professions › General Health Professions › Primary Care and Health Outcomes
- Keywords
- diabetes mellitus, preventive medicine, retinal examination, microalbuminuria screening, health maintenance organizations, health care utilization, quality of care
- MeSH terms
- Aged, Ambulatory Care, Cardiovascular Diseases, Cross-Sectional Studies, Diabetes Mellitus, Female, Health Maintenance Organizations, Health Services Research, Glycated Hemoglobin, Humans, Male, Middle Aged, Preventive Health Services, Quality of Health Care, Risk Factors, Washington
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