Missed appointments and poor glycemic control - An opportunity to identify high-risk diabetic patients
Missed appointments and poor glycemic control - An opportunity to identify high-risk diabetic patients
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DOI：
10.1097/01.mlr.0000109023.64650.73
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发表时间：
2004-02-01
期刊：
影响因子：
3
通讯作者：
Selby, JV
中科院分区：
文献类型：
--
作者：
Karter, AJ;Parker, MM;Selby, JV
目标。当患者错过预定的医疗预约时，医疗保健服务的连续性和有效性就会降低，对健康状况的适当监测就会失效，医疗服务的成本就会增加。我们评估了错过预约与血糖控制（糖化血红蛋白或HbA(1c)）之间的关系。研究设计与方法：2000年，在Kaiser Permanente北加州糖尿病登记中心的84040名患者中，未预约率与血糖控制有横断面相关性。调整后的HbA（1c）的最小二乘平均估计值是根据按糖尿病治疗分层的预约保持水平（无遗漏，1-30%遗漏，30 -30%遗漏）得出的。结果：2000年，12%的受试者错过了超过30%的预约。在调整了人口统计学因素（年龄、性别）、临床状况和医疗保健利用情况后，较高的失诊率与血糖控制明显较差相关。与参加所有预约的成员相比，错过bbbb30 %预约的成员调整后的平均HbA（1c）高出0.70至0.79点（P < 0.0001）。错过30%以上预约的患者不太可能每天自我监测血糖，并且口服药物补充依从性较差。结论：未充分使用护理的患者缺乏确定风险水平所需的记录信息。经常错过预约与较差的血糖控制和次优的糖尿病自我管理实践有关，在临床环境中很容易确定，因此可以作为临床应用的风险分层标准，表明需要有针对性的病例管理。
Objective. When patients miss scheduled medical appointments, continuity and effectiveness of healthcare delivery is reduced, appropriate monitoring of health status lapses, and the cost of health services increases. We evaluated the relationship between missed appointments and glycemic control (glycosylated hemoglobin or HbA(1c)) in a large, managed care population of diabetic patients.Research Design and Methods: Missed appointment rate was related cross-sectionally to glycemic control among 84,040 members of the Kaiser Permanente Northern California Diabetes Registry during 2000. Adjusted least-square mean estimates of HbA(1c) were derived by level of appointment keeping (none missed, 1-30% missed, and >30% missed appointments for the calendar year) stratified by diabetes therapy.Results: Twelve percent of the subjects missed more than 30% of scheduled appointments during 2000. Greater rates of missed appointments were associated with significantly poorer glycemic control after adjusting for demographic factors (age, sex), clinical status, and health care utilization. The adjusted mean HbA(1c) among members who missed >30% of scheduled appointments was 0.70 to 0.79 points higher (P < 0.0001) relative to those attending all appointments. Patients who missed more than 30% of their appointments were less likely to practice daily self-monitoring of blood glucose and to have poor oral medication refill adherence.Conclusion: Patients who underuse care lack recorded information needed to determine level of risk. Frequently missed appointments were associated with poorer glycemic control and suboptimal diabetes self-management practice, are readily ascertained in clinical settings, and therefore could have clinical utility as a risk-stratifying criterion indicating the need for targeted case management.