Provider type and the receipt of general and diabetes-related preventive health services among patients with diabetes.
OBJECTIVE
Using a measure of provider type that includes "shared care" to determine the contribution of provider type on receipt of general and diabetes-related preventive health services.


METHODS
Automated clinical and administrative data were used to identify adult patients with type 1 and 2 diabetes receiving care from a multispecialty, salaried group practice and enrolled in a large health maintenance organization between 3/97 and 2/98 (n = 10,991). Logistic regression models were fit using generalized estimating equation approaches to evaluate the contribution of provider type on service receipt.


METHODS
Preventive service receipt included receipt of glycated hemoglobin and lipid testing, retinal examinations, pneumococcal vaccines, Papanicolaou (Pap) smears, and mammograms. Multivariable analyses adjusted for age, sex, race, marital status, household income, diabetes-related comorbidities and complications, prescription drug use, laboratory testing results, and frequency of medical care contact.


RESULTS
Patients seeing an endocrinologist and primary care physician (PCP) were more likely than those seeing endocrinologists alone to receive glycated hemoglobin testing (OR, 1.42), lipid testing (OR, 1.72), mammograms (OR, 2.12), and Pap smears (OR, 2.36), and more likely than those seeing PCPs alone to receive glycated hemoglobin testing (OR, 1.79), lipid testing (OR, 1.54), retinal examinations (OR, 1.33), and mammograms (OR, 1.43). Compared with patients seeing PCPs only, patient's seeing endocrinologists only were more likely to receive retinal examinations (OR, 1.37) and less likely to receive Pap smears (OR, 0.46).


CONCLUSIONS
Care delivered by no one single provider type is associated with greater receipt of all recommended services. Instead, patients seeing both an endocrinologist and a PCP are most likely to receive recommended services.
Lafata
J E
JE
Henry Ford Health System, Detroit, Michigan, USA. jlafata1@hfhs.org
Martin
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S
Morlock
R
R
Divine
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Xi
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D000328:Adult; D015897:Comorbidity; D003922:Diabetes Mellitus, Type 1 / Q000150:complications / Q000517:prevention & control*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000517:prevention & control*; D004704:Endocrinology / Q000592:standards*; D005194:Family Practice / Q000592:standards*; D018588:Fee-for-Service Plans / Q000592:standards*; D005260:Female; D006123:Group Practice / Q000592:standards*; D019983:Guideline Adherence / Q000592:standards / Q000706:statistics & numerical data; D006279:Health Maintenance Organizations / Q000592:standards*; D006302:Health Services Research; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D008875:Middle Aged; D015999:Multivariate Analysis; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D014481:United States