Patient characteristics predicting failure to receive indicated care for type 2 diabetes

• Published in: Diabetes research and clinical practice 2015-02, Vol.107 (2), p.247-258
• Main Authors: Mounce, L.T.A, Steel, N, Hardcastle, A.C, Henley, W.E, Bachmann, M.O, Campbell, J.L, Clark, A, Melzer, D, Richards, S.H
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Antihypertensive Agents - therapeutic use; Cohort Studies; Delivery of Health Care - standards; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - drug therapy; Endocrinology & Metabolism; Female; Glycated Hemoglobin A - analysis; Healthcare Disparities - standards; Humans; Hypertension - drug therapy; Hypoglycemic Agents - therapeutic use; Interviews as Topic; Life Style; Logistic Models; Longitudinal Studies; Male; Middle Aged; Patient Care Bundles - standards; Patient education; Patient Education as Topic; Prediction; Predictive Value of Tests; Quality of care; Quality of Health Care - standards; Retrospective Studies
• ISSN: 0168-8227; 1872-8227
• DOI: 10.1016/j.diabres.2014.11.009

Abstract Aims To determine which patient characteristics were associated with failure to receive indicated care for diabetes over time. Methods English Longitudinal Study of Ageing participants aged 50 or older with diabetes reported receipt of care described by four diabetes quality indicators (QIs) in 2008–9 and 2010–11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle ( n = 907). A further QI ( n = 759) assessed whether participants with cardiac risk factors were offered ACE inhibitors or angiotensin II receptor blockers (ARBs). Logistic regression modelled associations between failure to receive indicated care in 2010–11 and participants’ socio-demographic, lifestyle and health characteristics, diabetes self-management knowledge, health literacy, and previous QI achievement in 2008–9. Results A third of participants (2008–9 = 32.8%; 2010–11 = 32.2%) did not receive all annual checks in the care bundle. Nearly half of those eligible were not offered ACE inhibitors/ARBs (2008–9 = 44.6%; 2010–11 = 44.5%). Failure to receive a complete care bundle was associated with lower diabetes self-management knowledge (odds ratio (OR) 2.05), poorer cognitive performance (1.78), or having previously received incomplete care (3.32). Participants who were single (OR = 2.16), had low health literacy (1.50) or had received incomplete care previously (6.94) were more likely to not be offered ACE inhibitors/ARBs. Increasing age (OR = 0.76) or body mass index (OR = 0.70) was associated with lower odds of failing to receive this aspect of care. Conclusions Quality improvement initiatives for diabetes might usefully target patients with previous receipt of incomplete care, poor knowledge of annual diabetes care processes, and poorer cognition and health literacy.