1228-P: Health Care Avoidance and Diabetes-Related Care among Medicare Beneficiaries with Type 2 Diabetes

Abstract

Healthcare avoidance among those with type 2 diabetes (T2D) can lead to increased risk for and severity of medical complications, resulting in potentially significant health and economic burdens. We examined the association between healthcare avoidance and diabetes-related care among Medicare beneficiaries with T2D. We analyzed the nationally representative 2017 Medicare Current Beneficiary Survey Public File of 2,001 Medicare beneficiaries aged ≥65 years with reported T2D. Three dichotomous outcomes were analyzed using multivariate survey-weighted logistic models including: i) self-testing blood glucose to manage one’s diabetes; ii) having had a health professional’s examination of one’s feet in the last year; and iii) maintaining one’s A1C ≤ 7.5% or average fasting blood test of ≤ 140 mg/dL all/most of the time (defined as "proper maintenance"). Among beneficiaries with T2D, 22.3% reported healthcare avoidance or “do anything to avoid going to the doctor.” Of those with healthcare avoidance, 58.7% reported oral medication use alone, 12.2% reported insulin use alone, and 19.4% reported both insulin and oral medication use, while 9.7% reported not using any medication to manage their diabetes. Further, 13.6% reported self-testing blood glucose to manage their diabetes, 25.1% reported having a health professional examine their feet in the last year, and 72.1% reported proper maintenance of blood glucose. Those with healthcare avoidance were less likely to report proper maintenance of blood glucose (OR= 0.65; 95% CI = 0.44,0.95; p < 0.026). Healthcare avoidance was not associated with the i) and ii) outcomes. This study found that those with healthcare avoidance were less likely to maintain proper blood glucose levels, making them especially at-risk of experiencing potentially preventable complications and costly care. Thus, stakeholders should target interventions (e.g., clinical outreach) to reduce the likelihood of healthcare avoidance among this vulnerable population. Disclosure B. Ng: None. S.D. Towne: None. J.B. LaManna: None. B.C. Peach: None. C. Park: None.