The lack of screening for diabetic nephropathy: Evidence from a privately insured population

Background: We examined the performance of screening tests for diabetic nep hropathy in a population of privately insured individuals. Methods: Adminis trative data from a large private health plan were analyzed. Continuously i nsured persons with diabetes (ages 30-62) with greater than or equal to one office visit during the study year (July 1995 to June 1996) were included (n=4,758). Outcome variables included a urinalysis for protein and a test f or microalbuminuria. The likelihood of test performance according to age, g ender; insurance plan type, total office visits, diabetes office visits, an d specialty of predominant physician was examined both in bivariate analyse s and a logistic regression. Results: Among the 4,623 patients without evid ence of nephropathy, only 16.5% had a urinalysis test conducted sometime in the year: All individuals (2.1% of sample) who received a microalbuminuria test also received a urinalysis. Individuals with indemnity or PPO plans w ere more likely to be screened than individuals in point-of-service plans. Patients with more visits and more diabetes visits were more likely to be s creened. In the regression with family practice as the reference category, general internists were the only physician specialty more likely to have sc reened patients. Conclusions: The majority of patients with diabetes mellit us do not receive annual screening for microalbuminuria or urinary protein.