Comparison of HTN management in patients with diabetes between rural and urban primary care clinics in Northeastern Colorado - a report from SNOCAP

INTRODUCTION: In the USA, rural residents have a higher burden of disease and more limited access to care than urban residents. There are conflicting data on quality of care in rural settings. To evaluate this relationship, blood pressure (BP) control and decision-making at the point of care in patients with diabetes were examined for rural and urban medical providers in Northeastern Colorado. METHODS: Twenty-six primary care practices in two practice-based research networks in Colorado participated: 13 in rural settings and 13 urban. Questionnaires were completed after each encounter with an adult with type 2 diabetes. The survey obtained: (1) demographic information; (2) BP result; (3) whether action was taken; (4) if action was taken, type of action; and (5) if no action, what reasons were given for this inaction. Bivariate and multivariate analyses were performed to identify predictors of action. RESULTS: In total, 778 surveys were completed. Mean BP was 130/74 (+/-18.8/12.0) with BP in rural residents being slightly lower than for urban residents. Rural residents were more likely to be non-Hispanic white, on Medicare, on multiple medications, and less likely to be on Medicaid. Sixty-five percent of urban patients exceeded BP goals, as did 58% of rural patients. Action rates for those with elevated BP in rural areas were not significantly different than those in urban areas (OR 0.75 [0.45-1.25] p = 0.27). The reasons for inaction were similar. CONCLUSION: In this study of patients with diabetes, quality of care for elevated BP was similar in rural and urban areas.