Organization and delivery of care: Co-morbidity and the utilization of health care for Australian veterans with diabetes

Abstract

Objective To examine the impact of co-morbidity on health service utilization by Australian veterans with diabetes. Methods A retrospective cohort study was undertaken including veterans aged ≥ 65 years dispensed medicines for diabetes in 2006. Data were sourced from the Australian Department of Veterans’ Affairs health claims database. Utilization of preventive health services for diabetes was assessed, including claims for glycated haemoglobin (HbA1c) test, microabuminuria, podiatry services, diabetes care plans, medication reviews, case conferences, general practitioner (GP) management plans and ophthalmology/optometry services. Results Among the 17 095 veterans dispensed medicines for diabetes, more than 80% had four or more co-morbid conditions. Those with a higher number of co-morbidities were more likely to have had claims for optometry/ophthalmology services and podiatry services, but not for other services. Veterans with at least one diabetes-related hospital admission had no more claims for diabetes health services than those who had no diabetics-related hospital admission, except for endocrinology services (relative risk = 1.26, 95% confidence intervals 1.15–1.37). Veterans with dementia were less likely to have had claims for diabetes health services while patients with renal failure were more likely to have had claims for the services. Conclusions Low utilization of preventive diabetes care services is apparent in all co-morbidity groups. Patients with renal failure or dementia used more and less health services resources, respectively. Given the high mean age of this population, there may be valid reasons for the low use, such as competing health demands and patients’ preferences.