Ethnic Differences in Appointment Keeping Affect Health of Diabetes Patients

Release Date: October 27, 2011 | By Laura Kennedy, Contributing Writer
Research Source: Health Services Research


  • Among patients with diabetes, Latinos and African-Americans are more likely to miss scheduled primary care appointments than Filipinos, Asians or Caucasians, according to a new study.
  • Patients who often miss primary care appointments have poorer control of blood sugar, blood pressure and cholesterol levels.
  • Providing same-day appointments to increase convenience and access may lead to more missed appointments for chronic disease maintenance, especially for Latinos and African Americans.
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Ethnic differences in appointment keeping may be an important factor in poor health outcomes among some minority patients with diabetes, according to a new study.

The researchers reviewed survey data and medical records for nearly 13,000 participants in the NIH-funded Diabetes Study of Northern California (DISTANCE) and found that some minority groups missed scheduled primary care appointments twice as often as others, even after accounting for many health and demographic factors. Latinos and African-Americans had the lowest rates of appointment keeping Asians had the highest, with Filipinos and Caucasians falling in between.

The study also found that patients who often miss appointments were at increased risk for poorer control of blood sugar, cholesterol, and blood pressure. Additionally, the study showed that these groups  tended to rely more heavily on same-day visits. This is the first study to evaluate primary care usage in a large, ethnically diverse group of diabetes patients with uniform access to health care. The findings have important implications for health care systems as they increase “open access” to care through same-day appointments, which may not provide the same level of chronic care management as planned visits, even when the appointment is with one’s own primary care provider.

“Providing greater convenience for patients may impact ethnic groups differently and perpetuate disparities in unexpected ways,” says lead author Melissa Parker, M.S., of Kaiser Permanente in California. The study appears in the current issue of Health Services Research.

Health care providers need to ensure that all aspects of diabetes care are addressed with patients who miss planned appointments but attend same-day appointments, say the authors. They note that during same-day appointments, primary care providers are trained to listen to patient complaints first, which may leave little time to focus on the diabetes-specific care that would be the focus of a planned visit.

They add that health indicators should be tracked separately for various segments of the population to ensure that open access does not compromise care for any ethnic group.

“This is part of the evolution of both patient and provider perspectives on how to best manage chronic illness,” says Robert Gabbay, M.D., Ph.D., who is director of the Penn State Hershey Institute for Diabetes and Obesity. “We still have a primarily acute care system. We are encouraging providers to address some chronic care issues at every appointment, even if the patient comes in for a different reason.”

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Tags for this article:
Patient Engagement   Minority Health and Health Disparities   Diabetes  

Comments on this article
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Susan Riley DNP, FNP, CDE says
October 27, 2011 at 8:31 PM

Question this an ethnicity problem or a financial problem..that is, do these subsets have inferior financial resources like health insurance causing them to miss appointments?
Comment: The same day appointment idea sounds good but if a patient with diabetes of any ethnicity is being seen for a “sick” appointment they are also less likely to be receptive to information about their diet, exercise and DM self management because they are focused on their back pain or flu that prompted them to come to the office that day. In a medical home model we have same day access but most use this for acute care needs and both provider and patient will do a more complete job of following chronic disease like diabetes when this is the major focus of the visit. Somewhere along the way we have lost the dual responsibility for good health between the patient and the provider and this has shifted to the provider being ultimately responsible for the health of his/her patients…should not the patient of any ethnicity be held responsible to come to scheduled appointments?

Debra Hall says
November 1, 2011 at 5:03 PM

In response to question one, I would speculate that ethnicity and financial problems may play into the cause of missed appointments. Some minority ethnic groups may have their own values and customs that influence their decision for not following for well office visits and check-ups. Financial, time, and travel time would most likely prevent some low-income uninsured individuals from keeping scheduled appointments. Diabetic indivuiduals seeking same-day visits for such things as flu, colds, and virses would benefit from a follow-up visit to revisit the chronic disease management after the acute illness has resolved. I have noticed in the home personal care setting participants are not given routine follow-up appointments. Participants are saying that they are being told to call for follow-up in 2 to 3 months. This leads to less frequent visits and impedes planning for those individuals who rely on family or public transportation.

Cathy Prescott says
November 8, 2011 at 12:10 PM

Trying to be a diabetes nurse in a free clinic. Classic example, two well-known Hispanics came in late in afternoon yesterday, after we had closed registration. Out of diabetes meds. again, plus wanting instant care for her sore throat at end of day when physician ready to leave.
Chronically late. Chronically absent for follow-up.
Hard to reward bad behavior with instant requests.
Report they couldn't comeback in two days when open again.
Frustrating for all. Suggestions?