Quality of Diabetes Mellitus Care by Rural Primary Care Physicians

Autor/inn/en	Tonks, Stephen A.; Makwana, Sohil; Salanitro, Amanda H.; Safford, Monika M.; Houston, Thomas K.; Allison, Jeroan J.; Curry, William; Estrada, Carlos A.
Titel	Quality of Diabetes Mellitus Care by Rural Primary Care Physicians
Quelle	In: Journal of Rural Health, 28 (2012) 4, S.364-371 (8 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0890-765X
DOI	10.1111/j.1748-0361.2012.00410.x
Schlagwörter	Statistical Significance; Patients; Diabetes; Physicians; Health Services; Correlation; Rural Areas; Physiology; Biochemistry; Diagnostic Tests; Place of Residence; Geographic Regions; Trend Analysis; Metabolism; Primary Health Care + Suchen Sie Ihr Suchwort? Patient; Physician; Doctor; Arzt; Health service; Gesundheitsdienst; Gesundheitswesen; Korrelation; Rural area; Ländlicher Raum; Physiologie; Biochemie; Diagnostic test; Diagnostischer Test; Wohnort; Trendanalyse; Stoffwechsel; Gesundheitsvorsorge
Abstract	Purpose: To explore the relationship between degree of rurality and glucose (hemoglobin A1c), blood pressure (BP), and lipid (LDL) control among patients with diabetes. Methods: Descriptive study; 1,649 patients in 205 rural practices in the United States. Patients' residence ZIP codes defined degree of rurality (Rural-Urban Commuting Areas codes). Outcomes were measures of acceptable control (A1c less than = 9%, BP less than 140/90 mmHg, LDL less than 130 mg/dL) and optimal control (A1c less than 7%, BP less than 130/80 mmHg, LDL less than 100 mg/dL). Statistical significance was set at P less than 0.008 (Bonferroni's correction). Findings: Although the proportion of patients with reasonable A1c control worsened by increasing degree of rurality, the differences were not statistically significant (urban 90%, large rural 88%, small rural 85%, isolated rural 83%; P= 0.10); mean A1c values also increased by degree of rurality, although not statistically significant (urban 7.2 [SD 1.6], large rural 7.3 [SD 1.7], small rural 7.5 [SD 1.8], isolated rural 7.5 [SD 1.9]; P= 0.16). We observed no differences between degree of rural and reasonable BP or LDL control (P= 0.42, P= 0.23, respectively) or optimal A1c or BP control (P= 0.52, P= 0.65, respectively). Optimal and mean LDL values worsened as rurality increased (P= 0.08, P= 0.029, respectively). Conclusions: In patients with diabetes who seek care in the rural Southern United States, we observed no relationship between degree of rurality of patients' residence and traditional measures of quality of care. Further examination of the trends and explanatory factors for relative worsening of metabolic control by increasing degree of rurality is warranted. (Contains 3 tables and 2 figures.) (As Provided).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10