Quality of diabetes mellitus care by rural primary care physicians.
OBJECTIVE
To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes.


METHODS
Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c < = 9%, BP < 140/90 mmHg, LDL < 130 mg/dL) and optimal control (A1c < 7%, BP < 130/80 mmHg, LDL < 100 mg/dL). Statistical significance was set at P < .008 (Bonferroni's correction).


RESULTS
Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P = .10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P = .16). We observed no differences between degree of rural and reasonable BP or LDL control (P = .42, P = .23, respectively) or optimal A1c or BP control (P = .52, P = .65, respectively). Optimal and mean LDL values worsened as rurality increased (P = .08, P = .029, respectively).


CONCLUSIONS
In patients with diabetes who seek care in the rural Southern United States, we observed no relationship between degree of rurality of patients' residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted.
The University of Alabama, Birmingham, Alabama 35294-3407, USA.
Stephen A
SA
Tonks
Sohil
S
Makwana
Amanda H
AH
Salanitro
Monika M
MM
Safford
Thomas K
TK
Houston
Jeroan J
JJ
Allison
William
W
Curry
Carlos A
CA
Estrada
D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D058007:Physicians, Primary Care / Q000592:standards*; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D011787:Quality of Health Care; D019035:Rural Health Services / Q000592:standards*; D015144:Southeastern United States / Q000453:epidemiology
D001786:Blood Glucose; D008077:Lipoproteins, LDL