Abstract
Background
Diabetes is one of the most widespread chronic condition. If
its complications are not prevented, diabetes is potentially
disabling for patients and costly for healthcare systems. An
effective management of diabetes care, addressing also patients’
socio-economic conditions, has to be realized. Several
strategies can be settled to reduce the impact of inequalities
in diabetes care. A systematic review was performed to determine whether implementation of clinical care strategies in
managed care is related to a reduction of inequalities in
diabetes care.
Methods
A systematic review was carried out by quering electronic
databases using the key-words ‘‘management’’, ‘‘diabetes’’,
[‘‘disparities’’ or ‘‘inequalities’’], combined with Boolean
operators. Furthermore, a snowball search was performed to
enlarge the number of articles. A quality assessment was
conducted too. All the studies concerning a specific evaluation
of strategies adopted in diabetes managed care to reduce
socio-economic disparities were selected. A data extraction
form was designed to record key information for each study:
authors, journal, year of publication, country, study sample,
study design, purpose of the study, variables considered,
disparities investigated. The attenuation in disparities was
analyzed pointing out the change in outcomes or outputs
grouped in different macro-areas.
Results
Out of 8408, six studies met the inclusion criteria. The selected
studies were published between 2006 and 2011 in USA and
Netherlands. Total sample regarded 54 454 people. Although
the setting was different for each study, in all of them a specific
strategy of managed care was applied to address socioeconomic
disparities. Investigated disparities were sociodemographic
variables, race/ethnicity, geographic location.
Four studies analyzed seven outcomes, whereas five studies
investigated 14 outputs. The most studied output (four
studies) was the frequency of HbA1c testing and it was not
observed an uniform result among the four studies.
Conclusion
Despite of remarkable investments of managed care programs
in underserved population, the role of specific strategies in
diabetes care to reduce disparities leads to very heterogeneous
results, with differences regarding to the type of indicator used
(outcomes or outputs).
Key message
This review contributes to the debate about disparities in
healthcare through the evaluation of the impact of managed
care strategies to reduce socio-economic disparities among
diabetes patients.
Lingua originale | English |
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pagine (da-a) | 297-298 |
Numero di pagine | 2 |
Rivista | European Journal of Public Health |
Volume | 24 |
Stato di pubblicazione | Pubblicato - 2014 |
Evento | 7th European Public Health Conference – “Mind the gap: Reducing inequalities in health and health care” - Glasgow Durata: 19 nov 2014 → 22 nov 2014 |
Keywords
- diabetes managed care
- inequalities