Using Enhanced Primary Care Services in High-risk Latino Populations to Reduce Disparities in Glycemic Control.

Abstract

To determine whether enhanced primary care services delivered preferentially to high-risk patients with diabetes (HbA1c >9%) can effectively reduce racial/ethnic disparities in glycemic control. This retrospective study analyzed electronic health records to examine changes in pre-vs. post-intervention disparities in HbA1c among Hispanics/Latinos relative to non-Hispanic Whites. Mean HbA1c and prevalence of poorly controlled diabetes improved in both racial/ethnic groups, but to a greater extent among Hispanics/Latinos. Mean HbA1c dropped 0.43 points further among Hispanics/Latinos than non-Hispanic Whites (95% CI, - 0.57 to - 0.29, p<.001). The change in disparity in prevalence of poorly controlled diabetes, measured as the ratio of post-vs. pre-intervention prevalence ratios, was 0.89 (95% CI, 0.84 to 0.94, p<.001). Both measures indicated greater reduction among Hispanics/Latinos relative to non-Hispanic Whites. Enhanced primary care services directed at high-risk patients may improve glycemic control and reduce racial/ethnic disparities in diabetes-related outcomes in medically underserved communities.