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Confronting Disparities in Diabetes Care: The Clinical Effectiveness of Redesigning Care Management for Minority Patients in Rural Primary Care Practices
Author(s) -
Bray Paul,
Thompson Debra,
Wynn Joan D.,
Cummings Doyle M.,
Whetstone Lauren
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.tb00101.x
Subject(s) - medicine , diabetes mellitus , context (archaeology) , family medicine , intervention (counseling) , practice nurse , diabetes management , disease management , pharmacist , primary care , physical therapy , nursing , type 2 diabetes , disease , pharmacy , parkinson's disease , paleontology , biology , endocrinology
Context : Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. Purpose : To explore the efficacy of combining care management and interdisciplinary group visits for rural African American patients with diabetes mellitus. Methods : In the intervention practice, an advanced practice nurse visited the practice weekly for 12 months and facilitated diabetes education, patient flow, and management. Patients participated in a 4‐session group visit education/support program led by a nurse, a physician, a pharmacist, and a nutritionist. The control patients in a separate practice received usual care. Findings : Median hemoglobin A1c (Hb A1c ) was not significantly different at baseline in the intervention and control groups but was significantly different at the end of the 12‐month follow‐up period (P<.05). In the intervention group, median Hb A1c at baseline was 8.2 ± 2.6%, and median Hb A1c at an average follow‐up of 11.3 months was 7.1 ± 2.3%, (P<.0001). In the control group, median Hb A1c increased from 8.3 ± 2.0% to 8.6 ± 2.4% (P<.05) over the same time period. In the intervention group, 61% of patients had a reduction in Hb A1c , and the percentage of patients with a Hb A1c of less than 7% improved from 32% to 45% (P<.05). Conclusions : These findings suggest that a redesigned care management model that combines nurse‐led case management with structured group education visits can be successfully incorporated into rural primary care practices and can significantly improve glycemic control.