Racial differences in impact of coverage on diabetes self-monitoring in a health maintenance organization

Medical Care
Connie MahDennis Ross-Degnan

Abstract

Insurance coverage of patient self-management devices like self-monitoring blood glucose (SMBG) equipment may help to reduce race-related barriers to effective care. We examined whether providing free home glucose monitors had greater impacts on self-monitoring among black versus white patients with diabetes. Using electronic medical record data (1992-1996), we used longitudinal survival analysis to examine racial differences in rates of initiation of SMBG after coverage and rates of discontinuation of SMBG 18 months after initiation. We used piecewise Cox models to compare relative rates of SMBG initiation between black and white patients before and after the policy. The study cohort included 2275 continuously enrolled adult patients with diabetes in a large, staff model HMO. Multivariate models were restricted to patients using oral therapy. Controlling for time-dependent and fixed effects, black patients were as likely to initiate SMBG as white patients before the policy (hazard ratio 1.14; 95% confidence interval 0.86-1.50) but more likely after the policy (hazard ratio 1.33; 95% confidence interval 1.01-1.76). Among postpolicy SMBG initiators, black patients were consistently at higher risk of SMBG discontinuation than whi...Continue Reading

References

Oct 1, 1993·Annals of Internal Medicine·S K Kumanyika
Dec 29, 2000·Diabetic Medicine : a Journal of the British Diabetic Association·S CosterR Swaminathan
Sep 28, 2002·Diabetes Care·Janice C Zgibor, David Simmons
Mar 28, 2003·BMC Health Services Research·Alyce S AdamsDennis Ross-Degnan
Mar 24, 2004·Archives of Internal Medicine·Stephen B SoumeraiDennis Ross-Degnan

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Citations

Sep 4, 2007·Journal of General Internal Medicine·Connie Mah TrinactyDennis Ross-Degnan
Jul 21, 2012·Endocrine·Jennifer A CampbellLeonard E Egede
Aug 22, 2008·Diabetes Technology & Therapeutics·John MastrototaroUNKNOWN STAR 1 Clinical Trial Investigators
Feb 10, 2009·BMC Health Services Research·Connie M TrinactyDennis Ross-Degnan
Mar 13, 2009·Medical Care Research and Review : MCRR·Bonnie B DeanRobert J Nordyke
May 19, 2020·Current Diabetes Reports·Rahul S Dadwani, Neda Laiteerapong

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