title: Does a 2.5-year self-management education and support intervention change patterns of healthcare use in African-American adults with type 2 diabetes?
abstract: OBJECTIVE
  To investigate the impact of a 2.5-year diabetes self-management education and support intervention on healthcare use and to examine factors associated with patterns of healthcare use.
  
  
  METHODS
  We recruited 60 African-American adults with type 2 diabetes who completed a 2.5-year empowerment-based diabetes self-management education and support intervention. Primary healthcare use outcomes included acute care visits, non-acute care visits and days lost to disability. Acute care was a composite score calculated from the frequency of urgent care visits, emergency department visits and hospitalizations. Non-acute care measured the frequency of scheduled outpatient visits. To examine change in patterns of healthcare use, we compared the frequency of healthcare visits over the 6-month period preceding the intervention with that in the last 6 months of the intervention.
  
  
  RESULTS
  No significant changes in patterns of healthcare use were found for acute care, non-acute care or days lost to disability. Multiple regression models found higher levels of depression (P = 0.001) to be associated with a greater number of non-acute healthcare visits, and found longer duration of diabetes (P = 0.019) and lower levels of diastolic blood pressure (P = 0.025) to be associated with fewer days lost to disability.
  
  
  CONCLUSIONS
  Participation in a long-term diabetes self-management education and support intervention had no impact on healthcare use in our sample of African-American subjects.
authors.affiliation: Department of Medicine, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: R O
authors.initials: RO
authors.lastname: Yeung
authors.forename: M
authors.initials: M
authors.lastname: Oh
authors.forename: T S
authors.initials: TS
authors.lastname: Tang
mesh_terms: D001741:Black or African American; D000368:Aged; D000553:Ambulatory Care / Q000706:statistics & numerical data*; D001794:Blood Pressure; D003863:Depression / Q000523:psychology; D003924:Diabetes Mellitus, Type 2 / Q000523:psychology / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010353:Patient Education as Topic / Q000379:methods*; D011209:Power, Psychological; D012044:Regression Analysis; D012648:Self Care / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome