Is Diabetes SelfManagement Education Desirable and Feasible in Primary Care

1
Is Diabetes Self-Management Education Desirable
and Feasible in Primary Care?
Trident/MUSC Family Medicine Residency
Program Morgan Arvidson, MD May 19, 2007
2
Background

• Diabetes is a leading cause of morbidity and
  mortality in primary care
• Diabetes Self-Management Education (DSME)
• Comprehensive programs to improve quality and
  efficiency of delivery of chronic disease
  management
• Uses management and team approach to improve
  patient outcomes
• Significant obstacles to chronic disease
  management remain

3
Quality Improvement to Diminish Obstacles

• Provider Obstacles
• Time constraints
• Patient Obstacles
• Lack of knowledge and/or motivation for
  prevention
• Health System Obstacles
• Reluctance of third party payers to reimburse
  group education

Ann Intern Med 2004140958-963.
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Purpose

• Is DSME desirable for physicians and patients?
• Is offering DSME in the primary care setting
  financially feasible?

5
Methods

• This project was approved as exempt research by
  the MUSC IRB
• Patient satisfaction
• 15-item survey developed by the American Diabetes
  Association
• Administered following group visits
• Scored on a 4-point scale
• poor, ok, good, or excellent

6
Methods

• Provider Satisfaction
• 28 item Provider Satisfaction Inventory (PSI)
• Previously validated by the Mayo Clinic
• Administered to referring providers at UFM
• 7-point numerical analog scale divided into one
  of four categories
• chronic disease management
• collaborative team practice
• outcomes
• supportive environment

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Methods

• Financial feasibility
• Calculated reimbursements versus estimated
  expense
• Based on 25 participation
• Compared Medicare, Medicaid, and Private
  reimbursement rates
• Based on initial visit 9 follow-up visits
• Program must have ADA certification
• Current Reimbursement Rates
• Medicare
• Initial Visit 28.40
• Follow-up Group Visit 16.48
• Medicaid
• Initial Visit 45.44
• Follow-up Group Visit 26.36

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Results

• Patients found the DSME program desirable
• N50

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Results of PSI

• N18, 78 response rate

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Results

• Providers who used DMSE expressed satisfaction
  with
• Continuity of care to patients with diabetes
• Delivery of better care through a team approach
• Providers who used DMSE expressed dissatisfaction
  with
• Lack of adequate time to spend with patients
• Efficiency of communication

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Results
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Conclusion

• Diabetes Self-Management Education
• Removes obstacles to quality chronic disease
  management
• Desirable for Providers
• Desirable for Patients
• Financially Feasible
• Improves outcomes
• Future goal further reduction of obstacles to
  quality chronic disease management