Receipt of diabetes preventive care among safety net patients associated with differing levels of insurance coverage.
BACKGROUND
Patients receive care in safety net clinics regardless of insurance status; however, receipt of diabetes preventive care might vary among patients with differing levels of insurance continuity.


METHODS
In a retrospective cohort study, using electronic health record data from adults with diabetes who were receiving care in 50 safety net clinics in Oregon in 2005 to 2007, we conducted adjusted logistic regressions to model the associations between amount of time with insurance and rates of receipt of lipid screening, influenza vaccination, nephropathy screening (urine microalbumin), and HbA1c (glycohemoglobin) screening.


RESULTS
Of 3384 adults with diabetes, 711 were partially insured (covered 1% to 99% of the 3-year study period), 909 had no coverage, and 1764 were continuously insured. In adjusted models, persons with partial or no coverage during the 3-year study period were less likely to receive most preventive services compared with those with continuous coverage. We found no evidence of a dose-response relationship with increasing duration of coverage, nor of a threshold amount of partial coverage, associated with better receipt of care.


CONCLUSIONS
Safety net clinic patients need both access to primary care and continuous insurance. All patients with partial coverage, regardless of the extent of time with insurance, had lower odds of receiving preventive care.
Kaiser Permanente Northwest Center for Health Research, Portland, OR 97227, USA. rachel.gold@kpchr.org
Rachel
R
Gold
Jennifer E
JE
DeVoe
Patti J
PJ
McIntire
Jon E
JE
Puro
Susan L
SL
Chauvie
Amit R
AR
Shah
D000328:Adult; D000368:Aged; D015331:Cohort Studies; D048909:Diabetes Complications / Q000517:prevention & control*; D057286:Electronic Health Records; D005260:Female; D006291:Health Policy; D006297:Health Services Accessibility; D006801:Humans; D019458:Insurance Coverage; D016015:Logistic Models; D008297:Male; D017057:Medically Uninsured; D008875:Middle Aged; D009922:Oregon; D011322:Primary Prevention; D012189:Retrospective Studies; D055815:Young Adult