1293-P: Health Center Services and Glycemic Control in Latinos with Diabetes

Background: Health centers (HCs) provide care to many racial and ethnic minority patients with diabetes. However, limited research has described the types of services HCs offer and their association with glycemic control.

Objective: To examine the relationship between HC services and glycemic control among Latino patients with diabetes.

Methods: We conducted a cross-sectional observational survey of providers in Midwestern HCs about the services offered at their sites. The provider-level report of HC services was summarized as medians of means per HC. HC-level data on glycemic control was obtained from the Uniform Data System. A linear mixed model was used to assess associations between the presence of HC services and the percent of Latino, non-Hispanic white, and overall patients with A1c <9% served at the HC.

Results: Survey responses were received from 620 providers practicing at 97 HCs in 10 Midwestern states. There were positive associations between percent of Latino patients with A1c <9% and access to community outreach workers/promotoras (p=0.01), and percent of overall patients with A1c <9% and access to a dietician (p=0.002). There were negative associations between the percent of Latino patients with A1c <9% and access to Spanish-speaking front desk staff (p=0.02) and provider education on diabetes (p=0.02). Serving a higher percentage of patients with diabetes who were Latino was negatively associated with the percent of Latino patients with A1c <9% (p=0.0003).

Conclusions: Access to promotoras and dieticians were associated with higher percentage of Latino patients with A1c <9%, suggesting the importance of a multidisciplinary approach to control of diabetes. Spanish-speaking front desk staff and provider education were associated with lower percentage of Latino patients with A1c <9%, likely related to high levels of HC efforts to address care needs. Future studies need to assess how access to specific services impact A1c control among Latinos with diabetes who receive care at community HCs.