Patient characteristics predicting failure to receive indicated care for type 2 diabetes

Mounce, L. T. A., Steel, Nicholas ORCID:, Hardcastle, Antonia, Henley, William E, Bachmann, Max ORCID:, Campbell, John, Clark, Allan ORCID:, Melzer, David and Richards, Suzanne (2015) Patient characteristics predicting failure to receive indicated care for type 2 diabetes. Diabetes Research and Clinical Practice, 107 (2). 247–258. ISSN 0168-8227

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Aims: 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 008-9. 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.

Item Type: Article
Uncontrolled Keywords: quality of care,prediction,patient education,sdg 3 - good health and well-being ,/dk/atira/pure/sustainabledevelopmentgoals/good_health_and_well_being
Faculty \ School: Faculty of Medicine and Health Sciences > Norwich Medical School
Depositing User: Pure Connector
Date Deposited: 16 Dec 2014 13:52
Last Modified: 19 Apr 2023 00:26
DOI: 10.1016/j.diabres.2014.11.009

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