OBJECTIVE -Care for chronic diseases may compete with preventive health care. To test this hypothesis, we examined the association between diabetes-related processes of care and preventive care in women.RESEARCH DESIGN AND METHODS -Using data from a prospective cohort study of diabetes care in managed care settings, we reviewed the care 540 diabetic women received from 355 primary care providers within 14 provider groups from one health plan. Of the 540 women, 278 were eligible to receive mammograms and 314 were eligible to receive Pap smears. Mammography performance was measured as at least one mammogram over a 2-year period and Pap performance was measured as at least one Pap smear over a 3-year period. To assess the association between diabetes-related processes of care and preventive services, we used hierarchical logistic regression models, accounted for clustering within provider groups, and adjusted for patient age, race, income and education level, diabetes treatment and duration, and health status, as well as physician age, sex, years of practice, and specialty. Diabetes-related processes of care were defined as dilated retinal examinations, urine microalbumin/protein testing, foot examinations, lipid and HbA 1c testing, recommendations to take aspirin, and influenza vaccinations received over a 1-year period.RESULTS -In this cohort, 73% of eligible women received mammograms and 56% received Pap smears. After adjustment of models, better diabetes-related processes of care, better health status, and non-Medicaid insurance were associated with mammography performance. Better diabetes-related processes of care, younger patient age, and any visit to a gynecologist were associated with Pap performance.CONCLUSIONS -Better processes of diabetes care were associated with better women's preventive health care. Diabetes management did not compete with sex-specific screening. Diabetes Care 28:2644 -2649, 2005I n the U.S., diabetes affects Ͼ9 million women over age 20 years (1). Many of these women receive suboptimal preventive care (2). Although there are many reasons for this deficiency, one unexplored explanation is that the provision of diabetes care interferes with preventive health care services. More specifically, the large number of diabetes-related services that need to be provided during a health care visit may compete for resources, and the demands of diabetes care may decrease the time available for preventive services (3). Some studies (4,5) have suggested that diabetic women may undergo sex-specific cancer screening (i.e., mammogram and Pap smear) less frequently than nondiabetic women. Suboptimal sex-specific screening in diabetic women may have serious implications in light of the increased risk for breast cancer in diabetic women (6) and the increased risk for breast and cervical cancer in overweight women (7).The characteristics associated with the performance of mammograms and Pap smears among diabetic women have not been well studied. Also, to our knowledge, no studies have examined the associat...
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