Abstract
Background
In the US, diabetes mellitus affects people in all racial and ethnic groups, but the prevalence and risk of complications are considerably higher among African Americans, Hispanics, American Indians, and Alaskan Natives. This study aimed to evaluate the impact of enrollment for at least 1 calendar year in a diabetes disease management program (DDMP) in a large, commercially insured, managed care population. We assessed changes in utilization of preventive services and adoption of diabetes self-management behaviors by race and ethnicity.
Methods
Participants were aged >17 years and had type 1 or 2 diabetes. They were enrolled in a targeted, high-risk level DDMP between January 2003 and September 2003 and were enrolled in the managed care organization (MCO) for a 2-year period beginning 1 year prior to their enrollment in the DDMP. At baseline, 19 483 MCO enrollees who were participating in the targeted high-risk level DDMP were mailed a 40-item, self-administered baseline survey, which took between 10 and 15 minutes to complete. Baseline results are reported elsewhere. One year later, in June 2004, 5174 of the baseline responders were mailed a slightly modified version of the 40-item survey. The survey measured use of eight preventive services (cholesterol test, dental examination, dilated eye examination, urinalysis, foot examination, influenza vaccination, pneumococcal vaccination, and glycated hemoglobin testing) and engagement in four self-management behaviors (blood glucose tests, diet monitoring, exercise, and smoking avoidance).
Results
Of the 5174 follow-up surveys mailed, 1961 (37.9%) were eligible for comparative analysis. Blacks and Hispanics reported more annual healthcare visits (average of 6.2 and 6.5, respectively) compared with Whites (average of 5.0, p < 0.0001). However, at follow-up, both Blacks and Hispanics had lower utilization rates than Whites for six of the eight preventive services that were measured. At follow-up, both Blacks and Whites were more likely than at baseline to report up-to-date status of influenza and pneumococcal vaccination (p ≤ 0.0001). At follow-up, the racial/ethnic gap in self-management behaviors that was observed at baseline had reduced and in fact had reversed direction for glucose tests, as Blacks were more likely than Whites to routinely test their blood glucose.
Conclusions
These data indicate that DDMP enrollment for at least 1 calendar year had a mixed impact on overall diabetes behaviors and on racial/ethnic disparities in preventive services utilization and self-management behaviors. Further studies are needed to give a clearer understanding of why some diabetic MCO enrollees are less likely to use preventive services, and why disparities remain even in settings where healthcare services are universally available.
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Acknowledgments
The authors thank Elizabeth Lowy, RN, Cheryl Walraven, MSW, Gwen Burchett, Rosalie Kaufman, RN, Lynn Morales, and Alana Lambert at Aetna Inc.; Stuart Sarshik, MD, and Poonam Alaigh, MD, at GlaxoSmithKline; and Junling Ren at the Emory Center on Health Outcomes and Quality for their contributions to the study. Clare Spettell and Charles Cutler are current employees of Aetna Inc. At the time the study was conducted, Verna Welch and Natalia Oster were employed by the Emory Center on Health Outcomes and Quality, and Michael Reardon was employed by Aetna Inc. The study was funded by the Aetna Quality Care Research Fund with resources from GlaxoSmithKline. The opinions expressed and conclusions reached are solely those of the authors and do not necessarily represent those of Aetna Inc. or GlaxoSmithKline.
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Welch, V.L., Oster, N.V., Gazmararian, J.A. et al. Impact of a Diabetes Disease Management Program by Race and Ethnicity. Dis-Manage-Health-Outcomes 14, 245–252 (2006). https://doi.org/10.2165/00115677-200614040-00007
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DOI: https://doi.org/10.2165/00115677-200614040-00007