Effect of a Primary Care-Based Diabetes Education Model on Provider Referrals and Patient Participation,The Science of Diabetes Self-Management and Care

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Effect of a Primary Care-Based Diabetes Education Model on Provider Referrals and Patient Participation
The Science of Diabetes Self-Management and Care ( IF 1.8 ) Pub Date : 2021-02-11 , DOI: 10.1177/0145721720981840
Jodi S Krall ₁ , Justin E Kanter ₁ , Kristine M Ruppert ₂ , Vincent C Arena ₂ , Francis X Solano ₁ , Linda M Siminerio ₂

Affiliation

Purpose

The purpose of this study was to evaluate the impact of a primary care (PC)-based delivery model on diabetes self-management education and support (DSMES) referrals and participation. Despite evidence that DSMES is a critical component of diabetes care, referrals and participation remain low.

Methods

PC practices were assigned to the intervention (n = 6) or usual care (n = 6). Intervention practices had direct access to a diabetes educator (DE) and applied patient-centered medical home elements to DSMES delivery. Usual care practices referred patients to traditional hospital-based outpatient DSMES programs. DSMES referrals and participation were examined for patients with diabetes, 18 to 75 years old, presenting to PC over 18 months (n = 4,894) and compared between groups.

Results

Compared to the usual care group, a higher percentage of patients in the intervention practices were referred to DSMES (18.4% vs 13.4%; P < .0001), and of those referred, a higher percentage of patients in the intervention practices participated in DSMES (34.9% vs 26.1%; P = .02). Patient-level factors predicting referrals were obesity (odds ratio [OR] = 1.6), higher A1C (OR = 1.4), female (OR = 1.3), and younger age (OR = 0.98). The only patient-level factor that predicted DSMES participation was lower A1C (OR = 0.9).

Conclusions

This study demonstrates the positive influence of a PC-based intervention on DSMES referral and participation. However, modest improvements in DSMES rates, even with targeted efforts to address reported barriers, raise questions as to what is truly needed to drive meaningful change.

中文翻译：

基于初级保健的糖尿病教育模式对提供者推荐和患者参与的影响

目的

本研究的目的是评估基于初级保健 (PC) 的交付模式对糖尿病自我管理教育和支持 (DSMES) 转诊和参与的影响。尽管有证据表明 DSMES 是糖尿病护理的重要组成部分，但转诊和参与率仍然很低。

方法

PC 实践被分配到干预 (n = 6) 或常规护理 (n = 6)。干预实践可以直接访问糖尿病教育者 (DE)，并将以患者为中心的医疗家庭元素应用于 DSMES 交付。通常的护理实践将患者转介到传统的医院门诊 DSMES 计划。对 DSMES 转诊和参与情况进行了检查，这些患者的年龄为 18 至 75 岁，在 PC 上就诊超过 18 个月（n = 4,894），并在组间进行比较。

结果

与常规护理组相比，干预实践中更高比例的患者被转诊至 DSMES（18.4% 对 13.4%；P < .0001），并且在被转诊的患者中，干预实践中更高比例的患者参与 DSMES （34.9% 对 26.1%；P = .02）。预测转诊的患者水平因素是肥胖（比值比 [OR] = 1.6）、较高的 A1C（OR = 1.4）、女性（OR = 1.3）和年轻（OR = 0.98）。预测 DSMES 参与的唯一患者水平因素是较低的 A1C（OR = 0.9）。