title: Primary care and health outcomes among older patients with diabetes.
abstract: OBJECTIVE
  The aim of this study was to measure the relationship between days spent waiting for primary care and health outcomes among patients diagnosed with diabetes, especially among the elderly population.
  
  
  METHODS
  Secondary data from VA administrative databases and Medicare claims.
  
  
  METHODS
  This is a retrospective observational study. Outcome variables include primary care utilization, mortality, heart attack, stroke, and ambulatory-care sensitive condition (ACSC) hospitalization. The main explanatory variable of interest is VA primary care wait time. Negative binomial models predict utilization and stacked logistic regression models predict the probability of experiencing each health outcome. Models are stratified by the presence of a selected health condition and age.
  
  
  RESULTS
  Longer wait times were predicted to decrease utilization between 2 and 4 percent. There was no significant relationship between wait times and health outcomes for the overall sample. In stratified analyses, longer waits were associated with undesirable outcomes for those over age 70 with one of the selected health conditions or in certain narrower 5-year age groups, but the overall pattern of results does not indicate a systematic and significant effect.
  
  
  CONCLUSIONS
  There was a modest effect of long wait times on primary care utilization but no robust effect of longer wait times on health outcomes. Waiting for care did not significantly compromise long-term health outcomes for veterans with diabetes.
authors.affiliation: Department of Veterans Affairs, Boston University School of Public Health, Health Care Financing and Economics, VA Boston Healthcare System, Boston, MA 02130, USA. julia.prentice@va.gov
authors.forename: Julia C
authors.initials: JC
authors.lastname: Prentice
authors.forename: B
authors.initials: B
authors.lastname: Graeme Fincke
authors.forename: Donald R
authors.initials: DR
authors.lastname: Miller
authors.forename: Steven D
authors.initials: SD
authors.lastname: Pizer
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003920:Diabetes Mellitus / Q000401:mortality / Q000628:therapy*; D005260:Female; D006297:Health Services Accessibility / Q000592:standards / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data; D014850:Waiting Lists
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