Does Patient Behavior or Access Factors Have the Largest Influence on Screening in Type 1 Diabetes?

Abstract

OBJECTIVE -Successful disease management is heavily influenced by access to care issues and patient behavior. Screening tests to detect chronic complications are part of diabetes management and may be influenced by access to care or patient decisions. The objective of this research was to examine how strongly access to care and patient behavior predict screening practices. RESULTS -Access-to-care issues positively predicted subsequent screening practices. Specifically, specialist care visits, number of doctor visits, and intensive insulin therapy were all strong predictors for screening use. Receipt of the recommended level of screening tests was also positively associated with the patient behavior of daily blood glucose testing. RESEARCH DESIGN AND METHODSCONCLUSIONS -The findings of this study show that access to care, in general, and access to quality diabetes care, in specific, play a key role in the use of recommended screening tests in type 1 diabetic patients. These data suggest that future efforts to improve screening practices in the type 1 diabetic population should address issues related to access to care. Diabetes Care 30:867-871, 2007D iabetes remains one of the most significant chronic illnesses affecting the U.S. population in terms of the number of people affected, related health care expenditures, and associated morbidity and mortality (1,2). Diabetic patients are at increased risk for developing chronic complications including nephropathy, retinopathy, neuropathy, peripheral vascular disease, and cardiovascular disease (2). Screening tests to detect early forms of these diseases are available, and routine screening for complications are widely recommended (3). However, currently few diabetic patients receive all recommended screening tests (4 -10).Optimal diabetes management includes components of screening and relies on a combination of patient and access factors that include provider and health care-system inputs (11). Multifaceted diabetes management programs are effective in improving glycemic control, monitoring lipid concentrations, and screening for diabetic retinopathy, foot lesions, peripheral neuropathy, and proteinuria (11). Diabetes is also unique in that a large component of disease management rests with the patient. Maintaining and monitoring glycemic control and adherence to diet, exercise, and prescribed medications are all essential daily components of diabetes management that are controlled by the patient (3).Disease management is predicated on appropriate patient self-management practices, physician adherence to evidence-based guidelines, and a health care system that facilitates these activities. Interventions that address provider feedback, provider education, provider reminders, patient education, patient reminders, and patient and provider financial incentives have been associated with improvements in provider adherence to recommended guidelines and patient outcomes (12). Interventions that address health care system factors such as central computerized tracking systems a...