Disparities in diabetes self-management education for uninsured and underinsured adults.
To examine accessibility, availability, and quality of diabetes self-management education (DSME) for uninsured adults or those utilizing Medicaid in a community with a high poverty rate.



A descriptive needs assessment was conducted in 8 health care agencies serving the uninsured. Face-to-face audiotaped interviews were conducted with 22 health care providers, educators, and administrators to capture descriptive characteristics about clinical care, DSME, continuity of care, and organizational function.



Twenty-nine percent of adults with diabetes were reported to be uninsured or utilizing Medicaid in these settings. Only 4% of adults received the American Diabetes Association's DSME standards of care. At 5 agencies, there was no direct access to DSME. Uninsured individuals had access to 2 programs; individuals utilizing Medicaid had access to 1 program. Certified diabetes educators were available at only 3 agencies. There were DSME programs that adhered to recommended guidelines but limited availability for these adults. The majority of education (86%) was limited to clinical encounters with providers, which were infrequent and variable in duration. Time spent on education ranged from 2 to 120 minutes depending on agency type. Education topics addressed by providers varied by agency.



Findings of this study suggest that adults who are utilizing Medicaid or are uninsured do not get the amount, type, or quality of DSME needed to sustain successful self-management. Limited availability and inadequate access to quality DSME place vulnerable adults at increased risk for devastating and costly complications despite the known benefits.
The Division of Adult and Senior Health, University of Colorado Anschutz Medical Campus, Aurora, Colorado (Ms Shaw)
Kathy
K
Shaw
The Department of Biobehavioral Nursing, Georgia Health Sciences University College of Nursing, Athens, Georgia (Dr Killeen, Ms Bowman)
Maureen
M
Killeen
Brenau University, Gainesville, Georgia (Ms Sullivan)
Erin
E
Sullivan
The Department of Biobehavioral Nursing, Georgia Health Sciences University College of Nursing, Athens, Georgia (Dr Killeen, Ms Bowman)
Patricia
P
Bowman
D000328:Adult; D003920:Diabetes Mellitus / Q000628:therapy*; D019538:Health Care Surveys; D054625:Healthcare Disparities; D006801:Humans; D008484:Medicaid; D017057:Medically Uninsured; D020380:Needs Assessment; D010353:Patient Education as Topic; D011203:Poverty; D012648:Self Care; D015144:Southeastern United States; D014481:United States