NEW YORK — A concerted effort to bring diabetes educators to rural primary care practices in the Pittsburgh area led to substantial improvements in the quality of patient care.
In one practice, for example, use of critical monitoring tools rose significantly after a diabetes educator began visiting the practice and its patients.
Regular use of a dilated eye exam rose from 38% before the educator's visits to 75% during the program. The percentage of patients with diabetes who underwent a regular foot examination jumped from 57% before the educator program to 82%, Linda M. Siminerio, Ph.D., said at a meeting sponsored by the American Diabetes Association.
“We saw this in every practice,” she said. “When you put an educator in the practice, the staff becomes more aware of diabetes and what patients need, and patients [who have attended educational sessions] ask for more services,” said Dr. Siminerio, a health educator and director of the Diabetes Institute at the University of Pittsburgh. The diabetes educator program helps physicians deliver better chronic-disease management, and brings state-of-the-art medicine into the community.
Dr. Siminerio and her associates started the Pittsburgh Regional Initiative for Diabetes Education (PRIDE) with the goal of improving diabetes care and awareness by educating patients, providers, and the regional community through outreach programs in Western Pennsylvania.
The program included screening events, health fairs, telephone banks, and visits by diabetes educators to practices in all corners of the region.
The rural practice that Dr. Siminerio used as an example had 104 patients with diabetes, with an average age of 65. Before the program started, seven of these patients had met with a diabetes educator, seven had received nutrition counseling, and three had received exercise instruction.
After weekly visits by a diabetes educator, the level of care received by the patients improved. In addition to the increases in eye and foot examinations, the percentage of patients undergoing at least two measures of their hemoglobin A1c levels rose from 75% to 95%.
The percentage receiving monofilament testing as part of their foot examination rose from 47% before the program to 79%. Lipid profiling rose from 88% to 99%, and urinalysis increased from 62% to 81%.
Certain clinical measures also improved, with the average serum level of LDL cholesterol falling from 107 mg/dL to 98 mg/dL, and average systolic blood pressure dropping from 140 mm Hg to 135 mm Hg.
The clinical impact of the PRIDE program was more apparent in a compilation of data from four of the primary care practices that received point-of-service diabetes education.
In January 2003, before the education sessions began, the average HbA1c level among patients with diabetes in these practices was 7.6%. In December 2006, the average HbA1c level in these patients was 7.3%. The average LDL level before education began was 117 mg/dL; by 2006, the average LDL level had dropped to 100 mg/dL.
These findings also highlighted a shortcoming in the way that diabetes education was used. The patients referred by their physicians to see the visiting educators tended to be those with the highest HbA1c and LDL levels; many other patients with diabetes, especially those with better test results, did not meet with educators.
“We need to reach the entire diabetes population, not just those who are in bad shape,” Dr. Siminerio said.