Ethnic differences in attendance at primary care appointments may be an important factor in poor health outcomes among some minority patients with diabetes, according to a new study in the current issue of Health Services Research.
This study evaluated rates of missed appointments in a large, ethnically diverse group of diabetes patients with uniform access to health care.
Some minority groups were found to have missed scheduled doctor visits twice as often as others, even after accounting for many health and demographic factors. Latinos and African-Americans had the highest rates of poor appointment keeping, Asians had the lowest, and Filipinos and Caucasians fell in between, according to the lead author of the paper, Melissa M. Parker, M.S., with the Kaiser Permanente Northern California Division of Research.
Patients who frequently missed planned primary care appointments relied more heavily on same-day appointments, and experienced poorer control of blood sugar, cholesterol, and blood pressure, the most important diabetes risk factors.
“The study has important implications for health care systems as they offer ‘open access’ to care through same-day appointments which may not provide the same level of chronic care management as planned primary care visits,” said Parker. “Providing greater convenience for patients may impact ethnic groups differently and perpetuate disparities in unexpected ways.”
The researchers reviewed survey data and medical records for nearly 13,000 participants in the NIH-funded, Diabetes Study of Northern California (DISTANCE). The percentage of patients who missed more than one-third of scheduled primary care appointments within each of the five largest ethnic groups in the region was:
• Latinos 12 percent
• African-Americans 10 percent
• Filipinos 7 percent
• Caucasians 6 percent
• Asians 5 percent
“Health plans need to ensure that all aspects of diabetes care are addressed among patients who don’t show up for planned appointments but instead frequently attend same-day appointments. Providers are in charge of setting the agenda for planned appointments and thus typically prioritize diabetes care. On the other hand, patients largely set the agenda when they make a same-day appointment, and once the patient issues are addressed, there may not be enough time to attend to diabetes care.” said Andrew J. Karter, PhD, senior author and principal investigator of the DISTANCE Study.
The authors add that health indicators should be monitored separately across populations to ensure that open access does not compromise care for any subgroups.
Additional authors on the study include: Howard H. Moffet, MPH, Kaiser Permanente Division of Research; Dean Schillinger, MD, UCSF Division of General Internal Medicine; Nancy Adler, PhD, UCSF Department of Psychiatry and Department of Pediatrics; Alicia Fernandez , MD, UCSF Division of General Internal Medicine; Paul Ciechanowski, MD, MPH, University of Washington Department of Psychiatry and Behavioral Sciences.
Funding for the study was provided by the National Institute of Diabetes, Digestive and Kidney Diseases and the National Institute of Child Health and Human Development.