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 3.9 ) 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型对医疗服务提供者推荐和患者参与的影响

目的

这项研究的目的是评估基于初级保健（PC）的分娩模型对糖尿病自我管理教育和支持（DSMES）推荐和参与的影响。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实践被指定为干预（n = 6）或常规护理（n = 6）。干预措施可以直接接触糖尿病教育者（DE），并将以患者为中心的医疗住所要素应用于DSMES交付。通常的护理做法将患者转至传统的基于医院的门诊DSMES计划。对18至75岁，在PC上就诊18个月（n = 4,894）的糖尿病患者，检查了DSMES的转诊和参与情况，并进行了组间比较。

结果

与常规护理组相比，介入治疗中接受DSMES的患者比例更高（18.4％vs 13.4％；P <.0001），而接受介入治疗的患者中有更高比例的患者参与了DSMES （34.9％vs 26.1％; P = .02）。预测转诊的患者水平因素为肥胖（优势比[OR] = 1.6），较高的A1C（OR = 1.4），女性（OR = 1.3）和年龄较小（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）。