title: The effect of regular primary care utilization on long-term glycemic and blood pressure control in adults with diabetes.
abstract: OBJECTIVE
  Complications of diabetes mellitus (DM) can be reduced with regular preventive care and guidance on self-management. We investigated whether regular primary care utilization could improve glycemic control and blood pressure control among American Indian/Alaska Native people with DM.
  
  
  METHODS
  Patient characteristics, risk factors, and health outcomes were identified from electronic health records of a cohort of 2138 adults with DM who received care between 1995 and 2010 from Southcentral Foundation, a tribal provider. Bivariate probit regression models estimated the probability of glycemic control and blood pressure control as functions of regular primary care, risk factors, and access factors, while taking into account potential bias arising from voluntarily choosing to seek primary care services.
  
  
  RESULTS
  Regular primary care was associated with an 89% increased likelihood of blood pressure control (95% confidence interval [CI], 59-118%) and 177% increased likelihood of glycemic control (95% CI, 123-222%). Increasing the distance by 10 miles to primary care services reduced the likelihood of regular primary care by 3.7% (95% CI, -2.9% to -4.6%).
  
  
  CONCLUSIONS
  Regular primary care utilization over 16 years was associated with higher rates of blood pressure control and glycemic control for adults with DM. People living closer to primary care services had a better chance of improved outcomes.
authors.affiliation: From the Research Department, Southcentral Foundation, Anchorage, AK (JJS, VYH); and the Institute of Social and Economic Research, University of Alaska-Anchorage (MDB, RRF).
authors.forename: Julia J
authors.initials: JJ
authors.lastname: Smith
authors.affiliation: From the Research Department, Southcentral Foundation, Anchorage, AK (JJS, VYH); and the Institute of Social and Economic Research, University of Alaska-Anchorage (MDB, RRF). matthew.berman@uaa.alaska.edu.
authors.forename: Matthew D
authors.initials: MD
authors.lastname: Berman
authors.affiliation: From the Research Department, Southcentral Foundation, Anchorage, AK (JJS, VYH); and the Institute of Social and Economic Research, University of Alaska-Anchorage (MDB, RRF).
authors.forename: Vanessa Y
authors.initials: VY
authors.lastname: Hiratsuka
authors.affiliation: From the Research Department, Southcentral Foundation, Anchorage, AK (JJS, VYH); and the Institute of Social and Economic Research, University of Alaska-Anchorage (MDB, RRF).
authors.forename: Rosyland R
authors.initials: RR
authors.lastname: Frazier
mesh_terms: D000328:Adult; D000368:Aged; D001786:Blood Glucose; D001794:Blood Pressure; D015331:Cohort Studies; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000628:therapy*; D005260:Female; D006801:Humans; D006973:Hypertension / Q000517:prevention & control*; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*
chemical_list: D001786:Blood Glucose
keywords: Diabetes Mellitus; Indigenous Health Services; Primary Health Care