Access to Care

Uninsured and partially insured patients with diabetes are less likely to be screened at Federally Qualified Health Centers

Federally Qualified Health Centers (FQHCs) provide medical care to more than 15 million patients each year regardless of their insurance status. A new study nevertheless points to some gaps in center care for partially insured and uninsured patients with diabetes. Jennifer DeVoe, M.D., D.Phil., of Oregon Health & Science University, and colleagues reviewed practice management data obtained from more than 100 FQHCs in Oregon. They focused on whether or not patients with diabetes received four evidence-based preventive care services: screenings for high cholesterol and kidney problems (a complication of diabetes); getting the flu vaccine; and getting a blood test for hemoglobin A1C (HbA1c, average blood-sugar level), an indicator of diabetes.

One-third (32 percent) of all patients with diabetes were vaccinated against the flu. A little over a third (36 percent) were screened for LDL cholesterol and only 21 percent were screened for kidney problems. Compared with insured patients, those who were uninsured were 19 percent less likely to undergo LDL screening, 27 percent less likely to get a flu shot, and 22 percent less likely to be screened for kidney problems, but just as likely to get tested for HbA1c. Partially insured patients were 21 percent less likely to get a flu shot, 25 percent less likely to have at least one HbA1c test, and 23 percent less likely to be screened for LDL cholesterol. Even those patients insured for 3 quarters had no better screening rates than those insured for just 1 month. The study was supported in part by the Agency for Healthcare Research and Quality (HS16181).

See "Insurance continuity and receipt of diabetes preventive care in a network of Federally Qualified Health Centers," by Rachel Gold, Ph.D., M.P.H., Dr. DeVoe, Amit Shah, M.D., and Susan Chauvie, R.N., M.P.A.-H.A., in the April 2009 Medical Care 47, pp. 431-439.

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