No Insurance?

People with diabetes who don’t have healthcare insurance may be more likely to receive tests that monitor diabetes control and assess risk for complications at community and migrant health centers than they do at a private doctor’s office, according to researchers in North Carolina.

A report in the February 2002 issue of Diabetes Care examined medical records, which showed that people treated at community/migrant health centers were more likely than those treated by private physicians to have the tests that measure quality of care, including A1C tests (98 percent versus 75 percent), cholesterol tests (82 percent versus 51 percent) and urine protein tests (90 percent versus 25 percent).

Deborah S. Porterfield, MD, of the North Carolina Division of Public Health and Linda Kinsinger, MD, of the University of North Carolina conducted a cross-sectional review of 142 medical records from eight doctors’ offices and three community/ migrant healthcare centers in rural North Carolina.

Although people treated at the healthcare centers were more likely to have the necessary tests than those who saw private physicians, “outcomes were similar in the two settings and well below [goals],” the researchers note.

“Only 51 percent had blood pressure below the target of 140/90 mmHG, only 40 percent had reached the LDL target of 130 mg/dl, and only 63 percent were at or below the A1C target of 9.5 percent.”

Uninsured people with diabetes treated in community/migrant health-care centers “had higher quality of care as suggested by higher rates of process of care,” conclude the researchers. “Further work is required to replicate these findings and to understand which features of community/ migrant health care centers may facilitate quality care for the uninsured and are replicable in other settings.”

Clinical adviser’s note: The 2002 recommendations of the American Diabetes Association set goals for nonpregnant adults with diabetes that differ from those used in this study in the following ways: the ADA-recommended blood pressure goal is less than 130/80, the LDL (“bad”) cholesterol goal is less than 100 mg/dl, and the A1C goal is less than 7%.

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