Annual HbA1C Test Disparity among Health Insurance Schemes in Type 2 Diabetic Patients
Article Sidebar
Main Article Content
Abstract
Introduction: Provision of quality medical care to patients with type 2 diabetes mellitus (T2DM) could help them control symptoms and delay diabetic complications. One essential medical care service is annual glycosylated hemoglobin (HbA1C) test since it indicates how well diabetes is under controlled. However, disparity of this service among health insurance schemes may exist. The objectives of this study were to measure the proportion of T2DM patients who were annually tested for HbA1C and to identify factors associated with HbA1C annual test. Materials and Method: In this cross sectional study, T2DM patients were identified with ICD10 code (E11X) from electronic health records (EHRs) in 2011 from one 120 beds community hospital. HbA1C test results were also retrieved from the same EHRs. Inpatient medical records were excluded from this study. Proportion of patients with different health insurance scheme who received annual HbA1C test was analyzed by descriptive statistics. Logistic regression was used to identify factors associated with annual HbA1C test provided. Results: Of 2,656 T2DM patients identified, the proportion of patients who received annual HbA1C test was 45.29% in 2011. Statistical significant association between gender and receiving annual HbA1C test was observed. Male was less likely to receive HbA1C test than female (OR=0.77, 95% CI = 0.65-0.91, p<0.05). Patients who paid out of pocket or were under universal coverage scheme were less likely to receive annual HbA1C test than those under civil servant benefit scheme or direct reimbursement (OR = 0.35, 95% CI = 0.20-0.61, OR = 0.65, 95% CI = 0.51-0.82 respectively, all p<0.05). T2DM patients with comorbidities were likely to receive annual HbA1C test than those without comorbidity (OR = 3.95, 95% CI = 2.99-5.20, p<0.05). Conclusion: Different access to annual HbA1C test among gender, health insurance schemes and comorbidities exists. Healthcare provider team should be reminded to assure that all T2DM patients receive at least one annual HbA1C test.
Article Details
In the case that some parts are used by others The author must Confirm that obtaining permission to use some of the original authors. And must attach evidence That the permission has been included
References
Aekplakorn W, Chariyalertsak S, Kessomboon P, et al. Prevalence and management of diabetes and metabolic risk factors in Thai adults: the Thai National Health Examination Survey IV, 2009. Diabetes care. 2011; 34(9): 1980-5.
Barkhuysen P, de Grauw W, Akkermans R, et al. Is the quality of data in an electronic medical record sufficient for assessing the quality of primary care? J Am Med Inform Assoc. 2013.
Calsbeek H, Ketelaar NA, Faber MJ, et al. Performance measurements in diabetes care: the complex task of selecting quality indicators. Int J Qual Health Care. 2013.
Chauvel N, Le Vaillant M, Pelletier-Fleury N. Variation in HbA1c prescription for patients with diabetes in French general practice: an observational study prior to the implementation of a P4P programme. European journal of public health. 2013; 23(1): 61-6.
Jiamjarasrangsi W. Prevalence and estimated incidence of type 2 diabetes among working population in Bangkok: A preliminary report. Chula Med J. 2005; 49(2): 73-81.
Krairittichai U, Potisat S, Jongsareejit A, et al. Prevalence and risk factors of diabetic nephropathy among Thai patients with type 2 diabetes mellitus. J Med Assoc Thai. 2011; 94 Suppl 2: S1-5.
Matheka DM, Kilonzo JM, Munguti CM, et al. Pattern, knowledge and practices of HbA1C testing among diabetic patients in a Kenyan tertiary referral hospital. Globalization and health. 2013; 9(1): 55.
Perez-Cuevas R, Doubova SV, Suarez-Ortega M, et al. Evaluating quality of care for patients with type 2 diabetes using electronic health record information in Mexico. BMC medical informatics and decision making. 2012; 12: 50.
Potisat S, Krairittichai U, Jongsareejit A, et al. A 4-year prospective study on long-term complications of type 2 diabetic patients: the Thai DMS diabetes complications (DD.Comp.) project. J Med Assoc Thai. 2013; 96(6): 637-43.
Sriwijitkamol A, Moungngern Y, Vannaseang S. Assessment and prevalences of diabetic complications in 722 Thai type 2 diabetes patients. J Med Assoc Thai. 2011; 94 Suppl 1: S168-74.