Confronting disparities in diabetes care: the clinical effectiveness of redesigning care management for minority patients in rural primary care practices.
BACKGROUND
Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services.


OBJECTIVE
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.


RESULTS
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.
Bray
Paul
P
Bertie Memorial Hospital, University Health Systems, Windsor, NC 27983, USA. pbray@pcmh.com
Thompson
Debra
D
Wynn
Joan D
JD
Cummings
Doyle M
DM
Whetstone
Lauren
L
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000704:Analysis of Variance; D019090:Case Management / Q000458:organization & administration* / Q000592:standards; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000208:ethnology* / Q000451:nursing / Q000628:therapy*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism*; D006126:Group Processes; D006801:Humans; D008297:Male; D008875:Middle Aged; D009657:North Carolina / Q000453:epidemiology; D010353:Patient Education as Topic; D011320:Primary Health Care / Q000458:organization & administration* / Q000592:standards; D019035:Rural Health Services / Q000458:organization & administration* / Q000592:standards; D012424:Rural Population / Q000706:statistics & numerical data; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome
D006442:Glycated Hemoglobin