Confronting Disparities in Diabetes Care: The Clinical Effectiveness of Redesigning Care Management for Minority Patients in Rural Primary Care Practices

Autor/inn/en	Bray, Paul; Thompson, Debra; Wynn, Joan D.; Cummings, Doyle M.; Whetstone, Lauren
Titel	Confronting Disparities in Diabetes Care: The Clinical Effectiveness of Redesigning Care Management for Minority Patients in Rural Primary Care Practices
Quelle	In: Journal of Rural Health, 21 (2005) 4, S.317-321 (5 Seiten) PDF als Volltext Verfügbarkeit
Sprache	englisch
Dokumenttyp	gedruckt; online; Zeitschriftenaufsatz
ISSN	0890-765X
DOI	10.1111/j.1748-0361.2005.tb00101.x
Schlagwörter	Diabetes; Patients; African Americans; Rural Population; Intervention; Nurses; Caseworker Approach; Control Groups; Health Services; Primary Health Care; Rural Areas; Health Education; Group Instruction + Suchen Sie Ihr Suchwort? Patient; Afroamerikaner; Landbevölkerung; Health service; Gesundheitsdienst; Gesundheitswesen; Gesundheitsvorsorge; Rural area; Ländlicher Raum; Gesundheitsaufklärung; Gesundheitsbildung; Gesundheitserziehung; Gruppenunterricht
Abstract	Context: Diabetes mellitus and its complications disproportionately affect minority citizens in rural communities, many of whom have limited access to comprehensive diabetes management services. Purpose: 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. Findings: Median hemoglobin A1c (Hb[subscript A1c]) 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 less than 0.05). In the intervention group, median HbA1c at baseline was 8.2 plus or minus 2.6%, and median (Hb[subscript A1c]) at an average follow-up of 11.3 months was 7.1 plus or minus 2.3%, (P less than 0.0001). In the control group, median (Hb[subscript A1c]) increased from 8.3 plus or minus 2.0% to 8.6 plus or minus 2.4% (P less than 0.05) over the same time period. In the intervention group, 61% of patients had a reduction in (Hb[subscript A1c]), and the percentage of patients with a (Hb[subscript A1c]) of less than 7% improved from 32% to 45% (P less than 0.05). 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. (Author).
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Erfasst von	ERIC (Education Resources Information Center), Washington, DC
Update	2017/4/10