title: Patient characteristics predicting failure to receive indicated care for type 2 diabetes.
abstract: OBJECTIVE
  To determine which patient characteristics were associated with failure to receive indicated care for diabetes over time.
  
  
  METHODS
  English Longitudinal Study of Ageing participants aged 50 or older with diabetes reported receipt of care described by four diabetes quality indicators (QIs) in 2008-9 and 2010-11. Annual checks for glycated haemoglobin (HbA1c), proteinuria and foot examination were assessed as a care bundle (n=907). A further QI (n=759) assessed whether participants with cardiac risk factors were offered ACE inhibitors or angiotensin II receptor blockers (ARBs). Logistic regression modelled associations between failure to receive indicated care in 2010-11 and participants' socio-demographic, lifestyle and health characteristics, diabetes self-management knowledge, health literacy, and previous QI achievement in 2008-9.
  
  
  RESULTS
  A third of participants (2008-9=32.8%; 2010-11=32.2%) did not receive all annual checks in the care bundle. Nearly half of those eligible were not offered ACE inhibitors/ARBs (2008-9=44.6%; 2010-11=44.5%). Failure to receive a complete care bundle was associated with lower diabetes self-management knowledge (odds ratio (OR) 2.05), poorer cognitive performance (1.78), or having previously received incomplete care (3.32). Participants who were single (OR=2.16), had low health literacy (1.50) or had received incomplete care previously (6.94) were more likely to not be offered ACE inhibitors/ARBs. Increasing age (OR=0.76) or body mass index (OR=0.70) was associated with lower odds of failing to receive this aspect of care.
  
  
  CONCLUSIONS
  Quality improvement initiatives for diabetes might usefully target patients with previous receipt of incomplete care, poor knowledge of annual diabetes care processes, and poorer cognition and health literacy.
authors.affiliation: Primary Care Research Group and School of Public Health and Epidemiology, University of Exeter Medical School, United Kingdom.
authors.forename: L T A
authors.initials: LT
authors.lastname: Mounce
authors.affiliation: Norwich Medical School, University of East Anglia, United Kingdom.
authors.forename: N
authors.initials: N
authors.lastname: Steel
authors.affiliation: Norwich Medical School, University of East Anglia, United Kingdom.
authors.forename: A C
authors.initials: AC
authors.lastname: Hardcastle
authors.affiliation: Health Statistics Research Group, University of Exeter Medical School, United Kingdom.
authors.forename: W E
authors.initials: WE
authors.lastname: Henley
authors.affiliation: Norwich Medical School, University of East Anglia, United Kingdom.
authors.forename: M O
authors.initials: MO
authors.lastname: Bachmann
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, United Kingdom.
authors.forename: J L
authors.initials: JL
authors.lastname: Campbell
authors.affiliation: Norwich Medical School, University of East Anglia, United Kingdom.
authors.forename: A
authors.initials: A
authors.lastname: Clark
authors.affiliation: School of Public Health and Epidemiology, University of Exeter Medical School, United Kingdom.
authors.forename: D
authors.initials: D
authors.lastname: Melzer
authors.affiliation: Primary Care Research Group, University of Exeter Medical School, United Kingdom. Electronic address: s.h.richards@exeter.ac.uk.
authors.forename: S H
authors.initials: SH
authors.lastname: Richards
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000959:Antihypertensive Agents / Q000627:therapeutic use; D015331:Cohort Studies; D003695:Delivery of Health Care / Q000592:standards*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000188:drug therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D054625:Healthcare Disparities / Q000592:standards*; D006801:Humans; D006973:Hypertension / Q000188:drug therapy; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007407:Interviews as Topic; D008019:Life Style; D016015:Logistic Models; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D064872:Patient Care Bundles / Q000592:standards*; D010353:Patient Education as Topic; D011237:Predictive Value of Tests; D011787:Quality of Health Care / Q000592:standards*; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D006442:Glycated Hemoglobin; D007004:Hypoglycemic Agents
keywords: Patient education; Prediction; Quality of care