Improved Outcomes in Diabetes Care for Rural African Americans

• Published in: Annals of family medicine 2013-03, Vol.11 (2), p.145-150
• Main Authors: Bray, Paul, MA, LMFT, Cummings, Doyle M., PharmD, FCP, FCCP, Morrissey, Susan, MA, Thompson, Debra, DNP, RN, CDE, Holbert, Don, PhD, Tanenberg, Robert, MD, Wilson, Kyle, BS, Lukosius, Eric, BS
• Format: Article
• Language: English
• Subjects: African Americans - statistics & numerical data; Blood Glucose - analysis; Blood Pressure; Cholesterol, HDL - blood; Cholesterol, LDL - blood; Diabetes Mellitus, Type 2 - therapy; Female; Glycated Hemoglobin A - analysis; Humans; Internal Medicine; Male; Middle Aged; Original Research; Outcome Assessment (Health Care); Patient Education as Topic - methods; Patient-Centered Care - organization & administration; Patient-Centered Care - standards; Poverty; Primary Health Care - methods; Primary Health Care - organization & administration; Primary Health Care - standards; Quality Improvement - standards; Rural Health - statistics & numerical data
• ISSN: 1544-1709; 1544-1717
• DOI: 10.1370/afm.1470

Abstract Purpose Rural low-income African American patients with diabetes have traditionally poorer clinical outcomes and limited access to state-of-the-art diabetes care. We determined the effectiveness of a redesigned primary care model on patients’ glycemic, blood pressure, and lipid level control. Methods In 3 purposively selected, rural, fee-for-service, primary care practices, African American patients with type 2 diabetes received point-of-care education, coaching, and medication intensification from a diabetes care management team made up of a nurse, pharmacist, and dietitian. In 5 randomly selected control practices matched for practice and patient characteristics, African American patients received usual care. Using univariate and multivariate adjusted models, we evaluated the effects of the intervention on intermediate (median 18 months) and long-term (median 36 months) changes in glycated hemoglobin (hemoglobin A1c) levels, blood pressure, and lipid levels, as well as the proportion of patients meeting target values. Results Among 727 randomly selected rural African American diabetic patients (368 intervention, 359 control), intervention patients had a significantly greater reduction in mean hemoglobin A1c levels at intermediate (−0.5 % vs −0.2%; P