Diabetes-specific preventive-care practices among adults in a managed-care population - Colorado, Behavioral Risk Factor Surveillance System, 1995

Morbidity and Mortality Weekly Report, Oct 31, 1997

The findings in this report indicate that, although approximately three fourths of enrollees reported most preventive-care practices, two thirds had never heard the term hemoglobin "A-one-C," one fourth had not had their feet examined during the preceding year, and nearly one fifth did not receive an annual dilated-eye examination. Findings from previous studies indicate that HCPs check [HbA.sub.1c] infrequently (5). However, among persons with diabetes who received care from the Colorado MCO, a substantial proportion (87.0%) of those who were aware of [HbA.sub.1c] (33.1%) also reported the test was performed at least once during the preceding year, and chart reviews indicated that at least one [HbA.sub.1c] test had been recorded for approximately 90% of persons in the study (N. Calonge, Kaiser Permanente, personal communication, 1996). In Colorado, one reason for the reported low level of [HbA.sub.1c] checks by HCPs (28.8%) was the respondents' low level of familiarity with the term (33.1%). Therefore, until the general public is more familiar with the name of the test, medical records and laboratory data may provide more accurate information about use of the [HbA.sub.1c] test.

The findings in this report are subject to at least two other limitations. First, the findings are not generalizable to MCO enrollees with diabetes who used nonpharmacologic therapy, obtained diabetes medication from pharmacies outside the MCO, or who were enrolled for [is less than] 3 years. Overall, approximately 10% of preventive services received by MCO enrollees were performed outside the MCO (N. Calonge, Kaiser Permanente, personal communication, 1996). Thus, for some preventive-care indicators, telephone surveys may provide more comprehensive information than chart reviews regarding levels of preventive care in an MCO population. Second, self-reported data may be subject to recall bias. The accuracy of these data requires further assessment through comparison with data from medical records or other sources.

In the United States, the number of persons with diabetes who receive medical care from MCOs is increasing (9). The findings in this report regarding diabetes-specific self-care and HCP preventive-care practices in an MCO population illustrate the usefulness of the BRFSS to assess diabetes care and to monitor care practices (10), particularly in MCO populations. In addition, MCOs can use the BRFSS to monitor the quality of diabetes care to ensure a level of care that can reduce the effects associated with preventable acute and chronic complications and to foster collaboration between MCOs and state health departments to reduce the impact of diabetes. In Colorado, these findings are being used to target interventions to improve diabetes care and reduce complications among enrollees with diabetes in the MCO population.

(*) [HbA.sub.1c] is a glucosylated hemoglobin used to monitor long-term glycemic control because it reflects average blood glucose levels during 6-8 weeks.