title: Examining patient risk factors, comorbid conditions, participation, and physician referrals to a rural diabetes self-management education program.
abstract: The purpose of this study was to examine patients' diabetes risk factors, comorbid conditions, and patient participation in and primary care practitioner (PCP) referrals to a rural diabetes self-management education (DSME) program.
  
  
  
  A total of 295 patients in a rural community were identified by their PCP as having type 2 diabetes (T2D). Using patient information that was collected and entered into a diabetes data management system, patients' risk factors, comorbid conditions, and patient participation in and PCP referral patterns to a DSME program were examined.
  
  
  
  Of the 295 patients with T2D, 162 (65%) reported that they had never received any DSME services. Despite educator efforts to improve patient participation and PCP awareness of local DSME services, 123 (76%) of the 162 patients never received a subsequent referral for DSME. Those patients who did receive a referral had a higher number of risk factors and comorbid conditions than those who did not receive a referral. Eighty-three percent of the patients who received a PCP referral attended the DSME program.
  
  
  
  The findings reaffirm concerns that DSME patient participation and PCP referral practices are poor. Advocacy efforts should force policies and procedures that will make DSME a mandatory service and universally accessible. Unless referral practices are attended to, it is doubtful that the United States will reach the Healthy People 2010 objective for diabetes education.
authors.affiliation: The University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania (Dr Ruppert, Dr Siminerio)
authors.forename: Kristine
authors.initials: K
authors.lastname: Ruppert
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (Ms Uhler)
authors.forename: Amy
authors.initials: A
authors.lastname: Uhler
authors.affiliation: The University of Pittsburgh Diabetes Institute, Pittsburgh, Pennsylvania (Dr Ruppert, Dr Siminerio)
authors.forename: Linda
authors.initials: L
authors.lastname: Siminerio
mesh_terms: D000368:Aged; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic; D010414:Pennsylvania; D012017:Referral and Consultation; D012307:Risk Factors; D012423:Rural Health; D012648:Self Care; D012955:Societies, Medical