title: Improvements in care and reduced self-management barriers among rural patients with diabetes.
abstract: BACKGROUND
  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.
  
  
  OBJECTIVE
  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.
  
  
  RESULTS
  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.
authors.affiliation: Park County Diabetes Project, Livingston, Mont., USA.
authors.forename: Nancy
authors.initials: N
authors.lastname: Dettori
authors.forename: Benjamin N
authors.initials: BN
authors.lastname: Flook
authors.forename: Erich
authors.initials: E
authors.lastname: Pessl
authors.forename: Kim
authors.initials: K
authors.lastname: Quesenberry
authors.forename: Johnson
authors.initials: J
authors.lastname: Loh
authors.forename: Colleen
authors.initials: C
authors.lastname: Harris
authors.forename: Janet M
authors.initials: JM
authors.lastname: McDowall
authors.forename: Marcene K
authors.initials: MK
authors.lastname: Butcher
authors.forename: Steven D
authors.initials: SD
authors.lastname: Helgerson
authors.forename: Dorothy
authors.initials: D
authors.lastname: Gohdes
authors.forename: Todd S
authors.initials: TS
authors.lastname: Harwell
mesh_terms: D000368:Aged; D048909:Diabetes Complications / Q000517:prevention & control; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000628:therapy*; D005260:Female; D006266:Health Education; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D009009:Montana / Q000453:epidemiology; D011314:Preventive Health Services / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000458:organization & administration*; D012424:Rural Population; D012648:Self Care