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Improvements in Care and Reduced Self‐management Barriers Among Rural Patients With Diabetes
Author(s) -
Dettori Nancy,
Flook Benjamin N.,
Pessl Erich,
Quesenberry Kim,
Loh Johnson,
Harris Colleen,
McDowall Janet M.,
Butcher Marcene K.,
Helgerson Steven D.,
Gohdes Dorothy,
Harwell Todd S.
Publication year - 2005
Publication title -
the journal of rural health
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.439
H-Index - 57
eISSN - 1748-0361
pISSN - 0890-765X
DOI - 10.1111/j.1748-0361.2005.tb00078.x
Subject(s) - medicine , diabetes mellitus , psychological intervention , diabetes management , family medicine , emergency medicine , cohort , disease management , intensive care medicine , type 2 diabetes , nursing , disease , endocrinology , parkinson's disease
Context: Improved preventive care and clinical outcomes among patients with diabetes can reduce complications and costs; however, diabetes care continues to be suboptimal. Few studies have described effective strategies for improving care among rural populations with diabetes. Purpose: In 2000, the Park County Diabetes Project and the Montana Diabetes Control Program collaboratively implemented a countywide effort, which included health systems interventions and coordinated diabetes education, to improve the quality of diabetes care. Methods: Clinical data from the diabetes registries in 2 primary care practices, in addition to baseline and follow‐up telephone surveys, were used to evaluate improvements in care, outcomes, education, and barriers to self‐management. Findings: In the cohort of patients, the proportion receiving the following services increased significantly from 2000 to 2003: annual foot examination (43% to 58%), influenza (30% to 53%), and pneumoccocal immunizations (39% to 70%). The median hemoglobin A1c values decreased significantly from baseline to follow‐up (7.2% to 6.8%). Mean systolic and diastolic blood pressure decreased significantly over the 2 time periods (139 mmHg to 135 mmHg, and 78 mmHg to 75 mmHg, respectively). Significant decreases were also observed in barriers to self‐management, including lack of knowledge (decrease from 12% to 5%), difficulties making lifestyle changes (36% to 27%), cost of monitors and test strips (25% to 16%), cost of medications (37% to 24%), and diabetes education (22% to 4%). Conclusions: Findings suggest that system changes in primary care practices and the implementation of accessible diabetes education can improve care and reduce barriers for rural patients with diabetes.