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

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 (HbA1c) 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 < .05). In the intervention group, median HbA1c at baseline was 8.2 +/- 2.6%, and median HbA1c at an average follow-up of 11.3 months was 7.1 +/- 2.3%, (P < .0001). In the control group, median HbA1c increased from 8.3 +/- 2.0% to 8.6 +/- 2.4% (P < .05) over the same time period. In the intervention group, 61% of patients had a reduction in HbA1c, and the percentage of patients with a HbA1c of less than 7% improved from 32% to 45% (P < 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.