Survey identifies diabetes care opportunities, challenges to address for future strategies
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The 2021 National Practice and Workforce Survey published in The Science of Diabetes Self-Management and Care identified opportunities and challenges in diabetes care that can guide strategies for future workforce and practice settings.
“The first National Practice Survey (NPS) results were published in 2007. In 2021, the Association of Diabetes Care & Education Specialists conducted its eighth NPS to identify and document current diabetes care and education specialists’ practice and workforce trends,” Jan Kavookjian, PhD, MBA, associate professor of health outcomes research and policy at Auburn University Harrison College of Pharmacy, Alabama, and colleagues wrote. “In addition, to keep pace with the evolving diabetes care and education landscape, ADCES included several new questions in ... 2021 to assess emerging trends, facilitators, barriers to change, and challenges for the specialty.”
The survey included 61 questions for respondents with an additional 56 questions specific to diabetes care and education. Researchers administered this anonymous survey online to 39,258 diabetes care and education specialists or those who were part of a diabetes care team obtained from the ADCES and the Certification Board for Diabetes Care and Education.
From February to April 2021, 2,797 surveys were completed (93% women), resulting in an 11% response rate. However, according to the researchers, this low response rate may have been caused by health care professionals being more busy than usual during the COVID-19 public health emergency.
Of the respondents, 40% were nurses, 38% were registered dietitian nutritionists or nutritionists, 8% were nurse practitioners, 7% were health educators or coaches, 7% were PharmD or registered pharmacists, 3% were clinical nurse specialists and 5% were of other disciplines. Overall, 83% of respondents reported holding the certified diabetes care and education specialist credential or being board certified in advanced diabetes management.
In addition, respondents reported diverse care delivery models with traditional and nontraditional services and expanded care models, including population health/risk stratification models (18%), the chronic care model (25%), accountable care organizations (2%), managed care (16%) and more.
Up to 36% of respondents reported the inability to provide care or refer patients, mostly for pediatric and home care diabetes education. Compared with 10% of respondents reporting interacting virtually with patients in the NPS2017, 70% reported virtual interactions in the NPS2021. However, 12% of respondents reported being unable to provide telehealth or refer patients to it for diabetes care and education.
Regarding diabetes devices, 50% or more of respondents reported actively using meters, continuous glucose monitors, insulin pumps and digital health.
Approximately 52% to 54% of respondents reported being “not at all familiar” or “somewhat unfamiliar” with each target indicator regarding the financial impact of the diabetes self-management education and support (DSMES) services. Only 24% of respondents reported “always or nearly all the time” being involved with impacting revenue, cost and readmission rates.
When asked about their perceived influence on DSMES care, respondents reported the following:
- 92% reported influence on medication management, 86% on insulin initiation, 88% on insulin titration and 85% on medication affordability or assistance for therapeutics;
- 90% reported influence on monitoring and data interpretation, 84% on integration of devices into practice and 81% on medication delivery device selection for devices;
- 97% reported influence on healthy eating recommendations, 96% on physical activity recommendations, 93% on stress reduction, 83% on peer support referrals, 73% on eye exams, 78% on foot exams, 97% on problem-solving, 96% on reducing risks and 95% on healthy coping for person-centered care; and
- 80% reported influence on telehealth integration and 86% on community collaboration on delivery of care.
“There are currently not enough diabetes care and education specialists to meet the needs of the diabetes and prediabetes population, and this, coupled with the high demands and lack of adequate staffing identified in NPS2021, indicates the need for workforce leveraging to address these gaps,” the researchers wrote.
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