Study shows shortfalls in achieving standards of care for diabetic patients
Study shows shortfalls in achieving standards of care for diabetic patients
Vast majority don’t get annual eye exams, total cholesterols
A major survey of over 2 million commercially insured patients, including nearly 16,000 diagnosed diabetics, shows the vast majority do not receive annual eye exams or total cholesterol tests, even though the American Diabetes Association guidelines call for such testing. The survey of patients who took insulin or oral agents was conducted by The Medstat Group of Ann Arbor, MI, and showed only 29% had annual eye exams and only 46% had cholesterol tests.
Medstat also measured triglycerides, high-density lipoprotein and low-density lipoprotein cholesterol, and HBA1c levels, which company officials said showed similar low compliance, but they declined to release the statistics on the grounds they are "proprietary."
The survey showed similar shortfalls in practice for patients with asthma and congestive heart failure.
The results were "significantly below expectations," according to Medstat’s medical director, Louis Diamond, MD, FACP. "We can’t expect 100% will get the annual exams, but I’d like to see it in the 80% to 90% range. That would make me feel much more comfortable."
"This is an indictment of the system," says Dennis Becker, MA, MPH, the company’s senior vice president. "Clearly, in terms of recommendations for diabetes care, there is a gap in terms of practice."
The reasons for the gap are related to lack of patient education, Becker says. "If the patients don’t know what to ask for, especially those with chronic conditions, they won’t get what they need." However, with a great deal of information now available on the Internet, "Patients are getting more savvy."
Diamond says the blame for the shortfall lies with the physicians, the health care team, managed care, and with the patients. "All of them have to work together to make these things happen," he says. "If only one plays a role, it becomes very difficult." However, he points out, "Most patients are compliant if you provide them with the information so they can understand why they should have a certain test."
Neither Diamond nor Becker say there is a plot to keep patients from getting the tests they need. "It’s driven by a lack of the system monitoring itself," says Diamond. "If the systems don’t know what or where the gap is, they’re not going to fill it. It’s as simple as that."
Medstat specializes in health care information and offers information bases, research, and consulting services to consumers, providers, managed care, and insurance organizations, governments, and research institutions.
"Our purpose is to bring more focus to the issues in health care and stimulate discussion," says Becker.
Tip of the iceberg?
Medstat’s results parallel those of other researchers and of government payers, says Ida Hellander, MD, executive director of Physicians for a National Health Program in Chicago. The shortfall in eye exams and total cholesterol is a flag for serious shortcomings across the board, not only in the treatment of diabetics but management of virtually every chronic disease, she adds.
She notes that Medstat’s study looked at those with insurance. "What about the 45 million people who have no insurance?"
"This is just the tip of the quality-of-care iceberg, says Hellander. "A lot of it is economic, because our system is so fragmented and so profit-oriented. The whole system is not set up for quality patient care, it’s designed to make investors money." She says managed care systematically excludes patients from preventive care for economic reasons since the average patient only stays in an HMO for 18 months. "There are a lot of financial incentives to deny care."
Aetna-US Healthcare takes exception to the accusations and points out its aggressive efforts to be sure diabetics and other sufferers from chronic diseases get the preventive care they need.
"We are across the board at above 50% of our patients getting the testing on scheduled as recommended by the ADA," says Joseph Carver, MD, Aetna’s senior medical director in Bluebell, PA. He says that is a substantial improvement since only about 30% of diabetics were getting annual eye exams five years ago.
Aetna searched its databases back to 1994 to identify everyone with diabetes, and further identified everyone who hadn’t had an eye exam in the past 12 months, says Carver. Patients were sent a letter urging them to schedule an eye exam. Lists of diabetics who had not received eye exams were also sent to their physicians, who were encouraged to make direct patient contact to be sure the exams were scheduled. Aetna also pegs compliance on diabetic exams to physician compliance ratings.
The company also has an education module, "Caring for Diabetes," which is offered to every diabetic patient in the system. Patients receive a letter of invitation to the workshop if they live close to a site where one is available. Those who are identified at high risk are also contacted by telephone. In addition, all of Aetna’s diabetic patients are given blood glucose monitors. A general mailing to all diabetics is sent twice a year, and patients identified as moderate to high risk are contacted four times a year for office visits, labs and necessary tests. "It’s a sophisticated system and it’s working," Carver concludes.
[Contact Dennis Becker and Louis Diamond at (734) 913-3295, and Ida Hellander at (312) 554-0382. Medstat is a sister company of American Health Consultants.]
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