title: Receipt of diabetes preventive services differs by insurance status at visit.
abstract: BACKGROUND
  Lack of insurance is associated with suboptimal receipt of diabetes preventive care. One known reason for this is an access barrier to obtaining healthcare visits; however, little is known about whether insurance status is associated with differential rates of receipt of diabetes care during visits.
  
  
  OBJECTIVE
  To examine the association between health insurance and receipt of diabetes preventive care during an office visit.
  
  
  METHODS
  This retrospective cohort study used electronic health record and Medicaid data from 38 Oregon community health centers. Logistic regression was used to test the association between insurance and receipt of four diabetes services during an office visit among patients who were continuously uninsured (n=1,117); continuously insured (n=1,466); and discontinuously insured (n=336) in 2006-2007. Generalized estimating equations were used to account for within-patient correlation. Data were analyzed in 2013.
  
  
  RESULTS
  Overall, continuously uninsured patients had lower odds of receiving services at visits when due, compared to those who were continuously insured (AOR=0.73, 95% CI=0.66, 0.80). Among the discontinuously insured, being uninsured at a visit was associated with lower odds of receipt of services due at that visit (AOR=0.77, 95% CI=0.64, 0.92) than being insured at a visit.
  
  
  CONCLUSIONS
  Lack of insurance is associated with a lower probability of receiving recommended services that are due during a clinic visit. Thus, the association between being uninsured and receiving fewer preventive services may not be completely mediated by access to clinic visits.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon. Electronic address: bailstef@ohsu.edu.
authors.forename: Steffani R
authors.initials: SR
authors.lastname: Bailey
authors.affiliation: Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon.
authors.forename: Jean P
authors.initials: JP
authors.lastname: O'Malley
authors.affiliation: Kaiser Permanente Northwest Center for Health Research, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
authors.forename: Rachel
authors.initials: R
authors.lastname: Gold
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon.
authors.forename: John
authors.initials: J
authors.lastname: Heintzman
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Division of Biostatistics, Oregon Health and Science University, Portland, Oregon.
authors.forename: Miguel
authors.initials: M
authors.lastname: Marino
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; OCHIN, Inc., Portland, Oregon.
authors.forename: Jennifer E
authors.initials: JE
authors.lastname: DeVoe
mesh_terms: D015331:Cohort Studies; D003151:Community Health Centers; D003920:Diabetes Mellitus / Q000517:prevention & control*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D019458:Insurance Coverage / Q000706:statistics & numerical data*; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D009922:Oregon; D011320:Primary Health Care; D012189:Retrospective Studies; D012709:Serum Albumin / Q000032:analysis
chemical_list: D006442:Glycated Hemoglobin; D012709:Serum Albumin; C517652:hemoglobin A1c protein, human