Appointment adherence and disparities in outcomes among patients with diabetes
Appointment adherence and disparities in outcomes among patients with diabetes
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DOI：
10.1007/s11606-008-0747-1
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发表时间：
2008-10-01
影响因子：
5.7
通讯作者：
Voss, John D.
中科院分区：
文献类型：
--
作者：
Schectman, Joel M.;Schorling, John B.;Voss, John D.
背景：成功控制糖尿病需要终生坚持多种自我管理活动，并与卫生专业人员密切合作。我们研究了农村卫生系统中这种控制与预约行为的关系。方法：在4253名主要是社会经济地位较低的糖尿病患者中，使用多元逻辑回归检查3年期间代谢控制（最近A1c < 7%或> < 9%，分别为“良好”和“差”控制两种模型）与“错过预约率”的关系。主要结果：漏约率每增加10%，控制良好的几率降低1.12倍（p < 0.001），控制不良的几率增加1.24倍（p < 0.001）。非裔美国患者的失约率明显高于白人患者（15.9% vs. 9.3%, p < 0.001）。在多变量分析中，控制了未预约率和保险状况，使控制良好的种族关联减弱，控制不良的种族关联不再显著。年龄较大、有健康保险的白人患者往往有更好的代谢控制。代谢控制与患者收入、性别或初级保健就诊次数没有独立的关联。结论：坚持预约，独立于就诊频率，是糖尿病代谢控制的有力预测因子。我们假设错过预约行为可以作为其他糖尿病依从性行为和相关障碍的指标，这些障碍有助于破坏成功的糖尿病自我管理。
BACKGROUND: Successful control of diabetes mellitus requires lifelong adherence to multiple self-management activities in close collaboration with health professionals. We examined the association of such control with appointment keeping behavior in a rural health system.METHODS: Among 4,253 predominantly lower socioeconomic status patients with diabetes, the association of metabolic control (most recent A1c < 7% or > 9% in two models of respectively 'good' and 'poor' control) with 'missed appointment rate' over a 3-year period was examined using multiple logistic regression.MAIN RESULTS: For each 10% increment in missed appointment rate, the odds of good control decreased 1.12 x (p < 0.001) and the odds of poor control increased 1.24 x (p < 0.001). The missed appointment rate was substantially higher among African-American patients (15.9% vs. 9.3% for white patients, p < 0.001). Controlling for the missed appointment rate and insurance status in multivariate analysis attenuated the racial association with good control, and the racial association with poor control was no longer significant. Older, white patients with health insurance tended to have significantly better metabolic control. There was no independent association of metabolic control with patient income, gender, or number of primary care visits.CONCLUSION: Adherence to appointments, independent of visit frequency, was a strong predictor of diabetes metabolic control. We hypothesize that missed appointment behavior may serve as an indicator for other diabetes adherence behaviors and associated barriers that serve to undermine successful diabetes self-management.