Racial/ethnic and educational-level differences in diabetes care experiences in primary care

Jackson, George L.; Weinberger, Morris; Hamilton, Natia S.; Edelman, David

doi:10.1016/j.pcd.2007.11.002

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Volume 2, Issue 1 , Pages 39-44, 2008

Racial/ethnic and educational-level differences in diabetes care experiences in primary care☆

George L. Jackson
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
- Corresponding author at: Durham Veterans Affairs Medical Center, HSR&D Service (152), 508 Fulton Street, Durham, NC 27705, USA. Tel.: +1 919 286 0411x7091; fax: +1 919 416 5836.
Morris Weinberger
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Health Policy and Administration, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
Natia S. Hamilton
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Psychology, North Carolina Central University, Durham, NC, USA
David Edelman
- Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA

Received 31 August 2007; received in revised form 12 November 2007; accepted 27 November 2007. published online 21 January 2008.

Abstract

Aims

To assess potential racial/ethnic and educational-level differences in the degree to which patients with diabetes who receive primary care from a Veterans Affairs Medical Center report that experiences with the diabetes care system are consistent with the Chronic Care Model (CCM).

Methods

A cross-sectional mailed survey of 296 patients included the Patient Assessment of Chronic Illness Care (PACIC), which measures components of the care system suggested by the CCM.

Results

Among 189 patients with complete information, non-white veterans had more than twice the odds of indicating that their diabetes care experience is in line with the CCM [measured by overall PACIC score ≥3.5] (OR 2.3; 95% CI 1.3–4.1). Non-white veterans were more likely to report high levels of assistance with problem solving and follow-up. Patients not completing high school had three times the odds of reporting care in line with the CCM (OR 3.0; 95% CI 1.2–7.6). Associations were also seen with implementation of the CCM in the areas of patient activation, perceived care teams, collaborative goal setting, and collaborative problem solving.

Conclusions

Non-white patients and those with less than a high school education had more than twice the odds of reporting that the diabetes care system is in line with the CCM.

Keywords: Diabetes, Health disparities, Chronic Care Model, Patient Assessment of Chronic Illness Care, United States Department of Veterans Affairs, United States