Diabetes care for older patients in America

Abstract

Underuse of diabetes care was common for older patients. This study examined whether patient or physician practice characteristics predict the likelihood of diabetes care. We studied the 2006 and 2007 National Ambulatory Medical Care Survey data for a nationally-representative sample of 2912 visits by older patients with diabetes. We examined the patterns of diabetes care, including diagnostic testing (glucose, haemoglobinA1c, blood pressure and cholesterol) and patient counselling services (diet/nutrition, exercise). Multivariate analysis was performed to identify independent predictors of diabetes care, controlling for patient and physician practice characteristics. All analyses were adjusted for the complex survey design. Having a designated primary care physician and the availability of electronic medical record or on-site laboratory testing were associated with more effective diabetes care (p < 0.05). If physician compensation relied on the productivity, physicians were less likely to provide diabetes care services (odds ratio = 0.5). The patterns of patient counselling and diagnostic testing services were similar (odds ratio = 2.5 and 18.2 for men; odds ratio = 1.8 and 9.6 for women). Older patients with diabetes were substantially more likely to receive diagnostic testing services than patient counselling. A designated primary care physician is crucial for providing recommended diabetes care services for older patients. Strengthening structural capabilities of primary care practices and implementing patient-centred primary care initiatives in concert with health system reforms are necessary to deliver the co-ordinated diabetes care with maximised health outcomes.