Pdb90 Feasibility of a Multi-Component Diabetes Management Intervention by Pharmacists: Coordination Within a Community Pharmacy Network

Abstract

Objectives: To evaluate differences in receipt of diabetes care services: A1C test, foot examination, dilated eye examination, flu vaccination and serum cholesterol test between privately health-insured and publicly health-insured diabetic subjects. Methods: Using the household component Medical Expenditure Panel Data Survey (MEPS) 2015 consolidated data, a secondary data analysis was carried out. Logistic regression was used to separately model the effect of insurance type on the receipt of each of the diabetes-care quality indicators: dilated eye examination, serum cholesterol test, foot examination, flu vaccination and A1C test. For subjects aged 18-64 yrs., private insurance-only versus public insurance-only users were compared using 348 eligible subjects, while for subjects above 64 yrs., Medicare-only versus Medicare plus private insurance users were compared using sample size of 240. Effects of age, education level, gender, income and race were controlled. Results: For subjects 18-64 yrs., the receipt of eye examination (OR 0.85, 95% CI: 0.51-1.41); foot examination (OR 0.716, 95% CI: 0.42-1.22), A1C test (OR 0.73, 95% CI: 0.40-1.34); flu vaccination (OR 0.901, 95% CI: 0.55-1.48); and serum cholesterol test (OR 1.35, 95% CI: 0.64-2.87); were not significantly associated with type of insurance coverage. Comparing Medicare versus Medicare plus private coverage for subjects above 64 yrs., the receipt of eye examination (OR 1.76, 95% CI: 0.88-3.50); feet examination (OR 1.13, 95% CI: 0.57-2.26), A1C test (OR 0.89, 95% CI: 0.38-2.08); and flu vaccination (OR 1.26, 95% CI: 0.63-2.50) were not significantly associated with type of coverage while odds of blood cholesterol test is higher (OR 1.35, 95% CI: 0.64-2.87) with Medicare plus private coverage users. Conclusions: Receipt of most key preventive and monitoring services among people with diabetes is similar between private and public insurance users, however elderly diabetic Medicare users with any additional private coverage are a little more likely to receive blood cholesterol test than Medicare-only users.