Pu J, Chewning B., Res Social Adm Pharm. 9(6):790-6. doi: 10.1016/j.sapharm.2012.11.005. Epub 2012 Dec 13., 2013 Nov 01
BACKGROUND: Diabetes has long been a leading cause of death in the United States, and worldwide. Diabetes-related preventive services are recommended to delay or to avoid diabetes complications. Racial disparity in the receipt of diabetes preventive care is well documented; however, little is known about the contributors to this disparity.
OBJECTIVE: This study aims to explore potential mediators linking race/ethnic disparities to reduced receipt of preventive care, and to better understand the dynamics underlying the relationships between race/ethnic characteristics and preventive care. Implications for pharmacist roles are explored.
METHODS: This study used 2008 Medical Expenditure Panel Survey (MEPS) data. The outcome of diabetes preventive care was assessed by participants' self-reports in MEPS. Household income and health insurance coverage were identified as potential mediators based on Andersen's Health Care Utilization Behavior model. Logistic regression was used to examine the direct effects of study independent variables on diabetes preventive care. Path analysis was conducted to identify racial disparities' direct and indirect effects on diabetes preventive care via potential mediators. All estimates were weighted to the U.S. non-institutionalized population.
RESULTS: Racial differences occurred with respect to receiving A1C tests, diabetic foot exams, and eye exams. After controlling for patient age, gender, living area, income, and health insurance status, racial differences persisted in diabetes preventive care. Hispanics were the least likely to receive all three elements of diabetes preventive care. In addition, patients were less likely to receive diabetes preventive care who were younger, lived in rural areas, had lower family income and were uninsured. A lower rate of diabetes preventive care in minority patients was partially explained by their higher rate of being uninsured or having low family income.
CONCLUSION: The results suggest that minority, rural, low-income, uninsured, and young diabetes patients are at a higher risk of not receiving diabetes preventive care. This study is unique in its use of path analysis to assess racial disparities in diabetes preventive care and to do so drawing on Andersen's Health Care Utilization Behavior model. In response to the disparity findings which were reinforced in this study, pharmacists have a need and an opportunity to help identify and address important gaps in diabetes preventive care through diabetes patient assessment, education, referral, and monitoring.