title: Does diabetes care compete with the provision of women's preventive care services?
abstract: 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.
  
  
  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.
authors.affiliation: Department of Internal Medicine, University of Michigan Health System, Ann Arbor, MI, USA.
authors.forename: Bahman P
authors.initials: BP
authors.lastname: Tabaei
authors.forename: William H
authors.initials: WH
authors.lastname: Herman
authors.forename: Annissa F
authors.initials: AF
authors.lastname: Jabarin
authors.forename: Catherine
authors.initials: C
authors.lastname: Kim
mesh_terms: D000368:Aged; D016009:Chi-Square Distribution; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006304:Health Status; D006801:Humans; D007348:Insurance, Health; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D016017:Odds Ratio; D065006:Papanicolaou Test; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011446:Prospective Studies; D014481:United States; D014626:Vaginal Smears / Q000706:statistics & numerical data; D014932:Women's Health Services / Q000706:statistics & numerical data*