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Self-management education, support, improved clinical health outcomes in patients with diabetes
Improving patient-centered medical homes and clinical health outcomes is possible with the integration and delivery of diabetes self-management education and diabetes self-management support, according to recent study findings published in The Diabetes Educator.
Charles E. Sepers Jr., BS, of the University of Kansas Work Group for Community Health and Development, and colleagues evaluated 173 patients from four patient-centered medical homes to determine the effects of a multisite coordinated care approach that delivered diabetes self-management education (DSME) and diabetes self-management support (DSMS).
Charles E. Sepers Jr.
The coordinated care approach included a DSME program with patient-tailored curricula, a DSMS program aimed at targeting the needs of underserved populations, better access to care services and changes to practice to target improving quality of diabetes clinical care. Intervention delivery began by October 2011, and program funding ended in July 2012. Some intervention elements continued after funding ended.
Researchers used key informant interviews with patient-centered medical home staff to determine implementation and sustainability of the intervention. Clinical health indicators, HbA1c, BMI, blood pressure, lipids and the American Association of Diabetes Educators 7 Self-Care Behaviors instrument were used to measure outcomes at baseline and 6 months.
Over all sites, 151 implementation activities were documented, and most were related to coordinated care (n = 132). Community and system changes were the next most frequently documented activities (n = 15). The greatest number of services provided were for the goals of improving access/linkage to care (n = 350; 32.8%) followed by improving clinical health outcomes (n = 348; 32.6%), increasing preventive health behaviors (n = 146; 13.7%), improving diabetes self-management (n = 128; 12%), improving quality of care (n = 75; 7%) and other (n = 20; 1.9%).
Patients with diabetes had decreased HbA1c after the implementation of the coordinated care approach (P = .01). One of the sites also showed significant decrease in HbA1c (P = .01) and BMI (P = .01) after implementation. Through the funded intervention period (September 2011 to July 2012), 128 services were provided across all sites. The mean change in HbA1c, the primary measure of implementation of the intervention and services provided during the intervention period showed a strong negative correlation (P = .038). However, increased intervention delivery was associated with improved blood glucose. No relationship was found between the remaining clinical outcomes and services provided during the intervention (P > .05).
After the grant period, 11 elements of the intervention were sustained or continued.
“This research suggests the value of systematic measurement of implementation within such an approach,” the researchers wrote. “Improvements in the quality and availability of diabetes care — especially among those experiencing health disparities — is essential among those experiencing equity and abiding by the value of social justice on which it is based.” – by Amber Cox
Disclosure: The study was funded in part by the Bristol-Myers Squibb Foundation.