Racial and ethnic differences in the effects of regular providers and self-management education on diabetes preventive care.

Abstract

To examine the effects of having regular healthcare providers and diabetes self-management education (DSME) on the receipt of diabetes preventive care among all groups and by race/ethnicity. The 2004 Behavioral Risk Factor Surveillance Survey. Logistic regression analyses were performed for the full sample and separately for Blacks, Hispanics, and Whites. Among all persons, having at least one regular provider and DSME were significantly associated with higher odds of receipt of a glycosylated hemoglobin (HbA1C) test, foot exam, and dilated eye exam in the past year. Results from analyses stratified by race/ethnicity reveal differential effects of having a regular provider and DSME. Among Whites, having at least one regular provider helps assure that diabetes patients receive each of the three recommended preventive services. Among Blacks, having at least one regular provider was significantly associated with receipt of an HbA1C but not other preventive services. Among Hispanics, having a regular provider was significantly associated with receipt of an HbA1C test and dilated eye exam, but not a foot exam. Independent of having a regular provider, DSME appears to be beneficial for Whites and Blacks but not Hispanics. For Whites, DSME was significantly associated with all three types of diabetes preventive care. For Blacks, DSME was significantly associated with the receipt of a foot exam but not an HbA1C test and a dilated eye exam. However, among Hispanics, DSME was not significantly associated with any of the three preventive services. Access to personal healthcare providers should be promoted among Whites, Blacks, and Hispanics to assure patients with diabetes receive recommended secondary preventive services. Diabetes self-management programs should also be expanded among Whites and Blacks but may need to be modified to benefit Hispanics.