Diabetes care: provider disparities in the US Appalachian region.
BACKGROUND
Diabetes is a devastating and growing problem in the USA and throughout the world. Parts of Appalachia, especially the most rural and economically 'distressed' areas of the region, have disproportionately high levels of diabetes incidence and have had long-standing problems in healthcare access.


OBJECTIVE
Little is known about the status of public health infrastructures and expertise available to address the diabetes epidemic, whether in Appalachia or elsewhere. This research examines the availability of professional diabetes care in Appalachia, including the economically distressed areas of the region.


METHODS
A 2006 cross-sectional survey of healthcare providers in the Appalachian Region identified diabetes service needs and availability in Appalachian healthcare facilities. Survey data and socioeconomic data were combined as a means to assess intra-regional variation in service availability.


RESULTS
Participants perceived that diabetes prevalence was growing in Appalachia and that they were seeing increasing numbers of persons with diabetes. Healthcare facilities in the region rarely employed specialized health professional providers and the expertise concerning diabetes in some clinicians may be limited.


CONCLUSIONS
The current and growing diabetes problem in Appalachia underscores the need for appropriate diabetes services and health professionals acquainted with current standards in diabetes care. Such problems in Appalachia have long been identified and linked with insufficient healthcare resources. The identification of ways to assure that local clinicians have current knowledge of diabetes standards of care is warranted.
Ohio University School of Nursing, Athens, Ohio, USA. denham@ohio.edu
Sharon A
SA
Denham
Lawrence E
LE
Wood
Karen
K
Remsberg
D000328:Adult; D001061:Appalachian Region / Q000453:epidemiology; D003430:Cross-Sectional Studies; D003922:Diabetes Mellitus, Type 1 / Q000453:epidemiology*; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology*; D006268:Health Facilities / Q000706:statistics & numerical data / Q000600:supply & distribution*; D054624:Health Status Disparities; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D011203:Poverty