RACIAL AND ETHNIC DIFFERENCES IN THE EFFECTS OF REGULAR PROVIDERS AND SELF-MANAGEMENT EDUCATION ON DIABETES PREVENTIVE CARE Objective: To examine the effects of having regular healthcare providers and diabetes self- management education (DSME) on the receipt of diabetes preventive care among all groups and by race/ethnicity. Data Source: The 2004 Behavioral Risk Factor Surveillance Survey. Methods: Logistic regression analyses were performed for the full sample and separately for Blacks, Hispanics, and Whites. Results: Among all persons, having at least one regular provider and DSME were significantly associated with higher odds of receipt of a glycosylated hemoglobin (HbA1C) test, foot exam, and dilated eye exam in the past year. Results from analyses stratified by race/ethnic- ity reveal differential effects of having a regular provider and DSME. Among Whites, having at least one regular provider helps assure that diabetes patients receive each of the three recommended preventive services. Among Blacks, having at least one regular provider was significantly associated with receipt of an HbA1C but not other preventive services. Among Hispanics, having a regular provider was significantly associated with receipt of an HbA1C test and dilated eye exam, but not a foot exam. Independent of having a regular provider, DSME appears to be beneficial for Whites and Blacks but not Hispanics. For Whites, DSME was significantly associated with all three types of diabetes preventive care. For Blacks, DSME was significantly associated with the receipt of a foot exam but not an HbA1C test and a dilated eye exam. However, among Hispanics, DSME was not significantly associ- ated with any of the three preventive services. Conclusion: Access to personal healthcare providers should be promoted among Whites, Blacks, and Hispanics to assure patients with diabetes receive recommended secondary preventive services. Diabetes self-management programs should also be expanded among Whites and Blacks but may need to be modified to benefit Hispanics. (Ethn Dis. 2006;16:786–791) Key Words: Continuity of Patient Care, Di- abetes, Disparities Anita K. Kurian, DrPH, MBBS; Tyrone F. Borders, PhD INTRODUCTION Improving quality of life for persons with diabetes by preventing or delaying the long-term complications of diabetes is critical. Improvements in diabetes preventive care have shown to be effective in reducing both the incidence and progression of diabetes-related health complications, but many Amer- icans fail to receive recommended di- abetes services. 1 Promoting the continuity of medical care is one potentially fruitful means of increasing access to diabetes preventive care. However, the literature on the impact of continuity of care, which is reflected by having a usual or regular healthcare provider, on the utilization of diabetes preventive services has yielded conflicting results. Mainous et al assessed the relationship between continuity of care and diabetes control by using the Third National Health and Nutrition Examination Survey (NHANES III) data and established no benefit of having a usual provider above having a usual site of care, but having any regular provider or site was associated with better glyce- mic control among people with diabe- tes. 2 In another cross-sectional analysis conducted on claims data from a private national health plan for one year, researchers showed that provider conti- nuity was not significantly associated with receipt of a glycosylated hemoglo- bin test (HbA1C), a lipid profile, or an eye examination. 3 On the other hand, Parchman et al reported that patients who had seen their usual providers within the past year were significantly more likely to have had an eye examina- tion, a foot examination, two blood pressure measurements, and a lipid anal- ysis. 4 Similar findings were also reported by O’Connor et al. 5 Although the potential benefit of greater continuity of care for persons with diabetes is debatable, having a regular provider contributes to a sustained patient-pro- vider relationship 6 and favorable overall health status. 7 Diabetes self-management educa- tion (DSME) is a component of the clinical management of diabetes. The American Diabetes Association (ADA) recommends assessment of self-manage- ment skills and knowledge of diabetes at least annually, and continuing diabetes education should also be provided. 8–10 Several quantitative and qualitative re- views have found that diabetes educa- tion results in successful behavior changes that influence positive health outcomes. 11,12 Persons who receive DSME may be more aware of the benefits of diabetes preventive care and thus more likely to utilize recom- mended services. Despite the body of literature about the benefits of regular providers and DSME, no previous study has simulta- neously examined their independent associations with the receipt of diabe- tes-related preventive care. Moreover, no prior study to our knowledge has assessed racial and ethnic differences in the effects of regular providers and DSME. Thus, the purpose of this study was twofold. First, we sought to exam- ine the degree to which regular pro- viders and DSME affect the odds of From the School of Public Health, University of North Texas Health Science Address correspondence and reprint requests to Anita K. Kurian, DrPH, MBBS; 1101 S. Main St., Ste. 2406; Fort Worth, TX 76104; 817-321-5372; 817-321-5496 (fax); akkurian@tarrantcounty.com Center (AK) and the Tarrant County Public Health (AK), Fort Worth, Texas; College of Public Health, University of Arkansas for Medical Sciences, Little Rock, Arkansas (TB). 786 Ethnicity & Disease, Volume 16, Autumn 2006