Confronting disparities in diabetes care: the clinical effectiveness of redesigning care management for minority patients in rural primary care practices

J Rural Health. Fall 2005;21(4):317-21. doi: 10.1111/j.1748-0361.2005.tb00101.x.

Abstract

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 (HbA1c) 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 HbA1c at baseline was 8.2 +/- 2.6%, and median HbA1c at an average follow-up of 11.3 months was 7.1 +/- 2.3%, (P < .0001). In the control group, median HbA1c 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 HbA1c, and the percentage of patients with a HbA1c 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.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • African Americans* / statistics & numerical data
  • Aged
  • Analysis of Variance
  • Case Management / organization & administration*
  • Case Management / standards
  • Diabetes Mellitus, Type 2 / blood
  • Diabetes Mellitus, Type 2 / ethnology*
  • Diabetes Mellitus, Type 2 / nursing
  • Diabetes Mellitus, Type 2 / therapy*
  • Female
  • Glycated Hemoglobin A / metabolism*
  • Group Processes
  • Humans
  • Male
  • Middle Aged
  • North Carolina / epidemiology
  • Patient Education as Topic
  • Primary Health Care / organization & administration*
  • Primary Health Care / standards
  • Rural Health Services / organization & administration*
  • Rural Health Services / standards
  • Rural Population* / statistics & numerical data
  • Severity of Illness Index
  • Time Factors
  • Treatment Outcome

Substances

  • Glycated Hemoglobin A