Appointment Adherence and Disparities in Outcomes Among Patients with Diabetes

Overview

Journal J Gen Intern Med

Publisher Springer

Specialty General Medicine

Date 2008 Jul 29

PMID 18661189

Citations 66

Authors

Joel M Schectman

John B Schorling

John D Voss

Affiliations

Soon will be listed here.

Abstract

Background: Successful control of diabetes mellitus requires lifelong adherence to multiple self-management activities in close collaboration with health professionals. We examined the association of such control with appointment keeping behavior in a rural health system.

Methods: Among 4,253 predominantly lower socioeconomic status patients with diabetes, the association of metabolic control (most recent A1c <7% or >9% in two models of respectively 'good' and 'poor' control) with 'missed appointment rate' over a 3-year period was examined using multiple logistic regression.

Main Results: For each 10% increment in missed appointment rate, the odds of good control decreased 1.12x (p < 0.001) and the odds of poor control increased 1.24x (p < 0.001). The missed appointment rate was substantially higher among African-American patients (15.9% vs. 9.3% for white patients, p < 0.001). Controlling for the missed appointment rate and insurance status in multivariate analysis attenuated the racial association with good control, and the racial association with poor control was no longer significant. Older, white patients with health insurance tended to have significantly better metabolic control. There was no independent association of metabolic control with patient income, gender, or number of primary care visits.

Conclusion: Adherence to appointments, independent of visit frequency, was a strong predictor of diabetes metabolic control. We hypothesize that missed appointment behavior may serve as an indicator for other diabetes adherence behaviors and associated barriers that serve to undermine successful diabetes self-management.

Citing Articles

Patient "No-Show" Prior to Elective Primary Total Hip Arthroplasty Increases Risk of Postoperative Anemia.

Mun J, Parry M, Tang A, Manikowski J, Crinella C, Mercuri J Arthroplast Today. 2025; 31():101602.

PMID: 39850465 PMC: 11754156. DOI: 10.1016/j.artd.2024.101602.

Racial/Ethnic Disparities in Access to Transportation Among Persons with Type 2 Diabetes Mellitus.

McClintock H, Edmonds S, Wang E J Racial Ethn Health Disparities. 2025; .

PMID: 39804504 DOI: 10.1007/s40615-024-02262-z.

Factors associated with foot self-care behaviour and foot screening attendance in people with type 2 diabetes: a cross-sectional study in primary care.

Zhu X, Tjhin S, Goh L, de Roza J, Chan F, Yin R BMJ Open. 2024; 14(12):e088088.

PMID: 39740946 PMC: 11749657. DOI: 10.1136/bmjopen-2024-088088.

Relationship between proxy behavior in clinic attendance and disease control among persons with hypertension and diabetes at a rural primary health center: A cohort analysis in South India.

Narendiran V, Ramasamy N, Sarkar S J Family Med Prim Care. 2024; 13(11):5220-5224.

PMID: 39722976 PMC: 11668391. DOI: 10.4103/jfmpc.jfmpc_873_24.

Medicaid insured persons with diabetes have increased proportion of missed appointments and high HbA1c.

Radhakrishnan R, Cade W, Bernal-Mizrachi E, Garg R Am J Med Open. 2024; 8:100022.

PMID: 39036517 PMC: 11256250. DOI: 10.1016/j.ajmo.2022.100022.

References

Blonde L, Karter A . Current evidence regarding the value of self-monitored blood glucose testing. Am J Med. 2005; 118(Suppl 9A):20S-26S. DOI: 10.1016/j.amjmed.2005.07.053. View

Hill-Briggs F, Gary T, Bone L, Hill M, Levine D, Brancati F . Medication adherence and diabetes control in urban African Americans with type 2 diabetes. Health Psychol. 2005; 24(4):349-57. DOI: 10.1037/0278-6133.24.4.349. View

Pincus T, Esther R, DeWalt D, Callahan L . Social conditions and self-management are more powerful determinants of health than access to care. Ann Intern Med. 1998; 129(5):406-11. DOI: 10.7326/0003-4819-129-5-199809010-00011. View

Karter A, Parker M, Moffet H, Spence M, Chan J, Ettner S . Longitudinal study of new and prevalent use of self-monitoring of blood glucose. Diabetes Care. 2006; 29(8):1757-63. PMC: 2213628. DOI: 10.2337/dc06-2073. View

Griffin S . Lost to follow-up: the problem of defaulters from diabetes clinics. Diabet Med. 1998; 15 Suppl 3:S14-24. DOI: 10.1002/(sici)1096-9136(1998110)15:3+<s14::aid-dia725>3.3.co;2-9. View

Shenolikar R, Balkrishnan R, Camacho F, Whitmire J, Anderson R . Race and medication adherence in Medicaid enrollees with type-2 diabetes. J Natl Med Assoc. 2006; 98(7):1071-7. PMC: 2569450. View

Trinacty C, Adams A, Soumerai S, Zhang F, Meigs J, Piette J . Racial differences in long-term self-monitoring practice among newly drug-treated diabetes patients in an HMO. J Gen Intern Med. 2007; 22(11):1506-13. PMC: 2219792. DOI: 10.1007/s11606-007-0339-5. View

Knowler W, Barrett-Connor E, Fowler S, Hamman R, Lachin J, Walker E . Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002; 346(6):393-403. PMC: 1370926. DOI: 10.1056/NEJMoa012512. View

Karter A, Ackerson L, Darbinian J, DAgostino Jr R, Ferrara A, Liu J . Self-monitoring of blood glucose levels and glycemic control: the Northern California Kaiser Permanente Diabetes registry. Am J Med. 2001; 111(1):1-9. DOI: 10.1016/s0002-9343(01)00742-2. View

10.

Selby J, Swain B, Gerzoff R, Karter A, Waitzfelder B, Brown A . Understanding the gap between good processes of diabetes care and poor intermediate outcomes: Translating Research into Action for Diabetes (TRIAD). Med Care. 2007; 45(12):1144-53. DOI: 10.1097/MLR.0b013e3181468e79. View

11.

Schectman J, Nadkarni M, Voss J . The association between diabetes metabolic control and drug adherence in an indigent population. Diabetes Care. 2002; 25(6):1015-21. DOI: 10.2337/diacare.25.6.1015. View

12.

Karter A, Parker M, Moffet H, Ahmed A, Ferrara A, Liu J . Missed appointments and poor glycemic control: an opportunity to identify high-risk diabetic patients. Med Care. 2004; 42(2):110-5. DOI: 10.1097/01.mlr.0000109023.64650.73. View

13.

Tuomilehto J, Lindstrom J, Eriksson J, Valle T, Hamalainen H, Ilanne-Parikka P . Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med. 2001; 344(18):1343-50. DOI: 10.1056/NEJM200105033441801. View

14.

Harris M, Cowie C, Howie L . Self-monitoring of blood glucose by adults with diabetes in the United States population. Diabetes Care. 1993; 16(8):1116-23. DOI: 10.2337/diacare.16.8.1116. View

15.

Heisler M, Faul J, Hayward R, Langa K, Blaum C, Weir D . Mechanisms for racial and ethnic disparities in glycemic control in middle-aged and older Americans in the health and retirement study. Arch Intern Med. 2007; 167(17):1853-60. DOI: 10.1001/archinte.167.17.1853. View