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Diabetes Education in Appalachia: Providers’ Views

Diabetes Education in Appalachia: Providers’ Views. S.A. Denham, K.E. Remsberg, & L. Wood Ohio University, Athens, Ohio Diabetes: A Family Matter Conference March 18, 2009. Acknowledgements.

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Diabetes Education in Appalachia: Providers’ Views

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  1. Diabetes Education in Appalachia: Providers’ Views S.A. Denham, K.E. Remsberg, & L. Wood Ohio University, Athens, Ohio Diabetes: A Family Matter Conference March 18, 2009

  2. Acknowledgements • Graduate assistants who contributed to this project by distributing surveys and compiling data were: • Cara Butcher • Tammy Collier • Eimi Lev • Patricia Harris • Stacey Hartman • Tara O’Brien • Funding sources: • CDC’s National Diabetes Education Program, • Ohio Department of Health Diabetes Prevention and Control Program • Ohio University, Diabetes Research Initiative & Appalachian Rural Health Institute, College of Health & Human Services, School of Nursing

  3. Epidemiology of Type 2 Diabetes • Prevalence of diabetes, U.S. 2008 all ages* • Total: about 24 million people (7.8% of the population) • Diagnosed: 17.9 million people • Undiagnosed: 5.7 million people • 1.5 million new cases diagnosed in 2005 • Mortality • 7th Leading cause of death • Under-reported (only 35-40% with diabetes had it listed on death certificates) • Twice as high as for others without diabetes • (2007) Direct costs $116 Billion Indirect Costs $58 Billion

  4. Prevalence of Diagnosed Diabetes United States, 2006 BRFSS [2006], CDC/Div. of Diabetes Translation 6.6 to 10.1% said yes to “Did a doctor tell you that you have diabetes?”

  5. Prevalence of Diagnosed Diabetes: Cincinnati, Ohio - 1999, 2002, 2005 2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book

  6. Prevalence of Diagnosed Diabetes: Cincinnati, Ohio - 2005 2005 Greater Cincinnati Community Health Status Survey: White Appalachian Chart Book

  7. Prevalence of Diagnosed Diabetes: Appalachian Ohio – 2006* 2006 ARHI

  8. The Reach of Diabetes Education • US Prevalence • About half of those with diabetes have taken a class on diabetes self-management, (52%) • Those older than 65 years of age are less likely (46%) • Diabetes Education and Insurance (under 65 years) • Uninsured (42%) • Medicare (46%) • Medicaid/Indian Health Service (49%) • Private Insurance (54%) • Veterans Administration (79%) • Other traits and Diabetes Education • More likely • Female • African American • Insulin Use • Less likely • Appalachian (Virginia Dept. Health, 2004)

  9. Study Purpose Evaluate provider perceptions about the provision of diabetes education throughout the Appalachian region of the United States.

  10. Distressed/At-Risk Locations • Distressed County • Poverty 1.5x national average • Unemployment > 1.5x national average • Per capita market income no more than 2/3 national average • OR, poverty 2x national average, plus unemployment or PCMI • At-Risk County • Poverty ≥ 1.25x national average • Unemployment ≥ 1.25x national average • Per capita market income no more than 2/3 national average • OR meeting 2 of 3 distressed criteria

  11. Survey Subjects • Federally Qualified Health Centers • N = 135 (54 clinics/hospitals and 81 HD) • Health Departments • N = 82 • Diabetes Educators • N = 47 (46 situated in hospitals/clinics and 1 in a HD)

  12. Questionnaire Topics • A 40-item questionnaire • Information collected from the survey: • Amount, type of diabetes education available • Providers of education • Patient barriers to receiving education • Provider obstacles to delivering education

  13. Statistical Analysis • Descriptive analyses of factors assessed by provider perceptions of Diabetes Education. • Cross-sectional comparison of percentages according to Distressed-At-Risk County status • P-values ≤ 0.05 were statistically significant

  14. Table 1: Study Area Characteristics by Distressed-At Risk Status

  15. Table 2: Diabetes Education Programs in Appalachia, by Distressed-At Risk Status

  16. Table 3: Patient Barriers for Scheduled Diabetes Education Sessions, by Distressed-At Risk Status

  17. Table 4: Perceived Resource Problems withDiabetes Education Programs, by Distressed-at Risk Status

  18. Discussion • Provision of Diabetes Education - Appalachia: • DAR may not be worse than NDAR • Provider needs: Lack of resources, medical specialists, staff and CDEs to provide diabetes education • Patient barriers: Lack of transportation, insurance, literacy • Perception/reality of increasing diabetes, costs • Lead to further discrepancy between diabetes and education/care needed.

  19. Recommendations • Fewer CDEs available in DAR, educators more likely to be busy RNs • CDEs more likely to be employed in hospitals than clinics and health departments • Fewer people in the Appalachian region appear to be getting diabetes education than nationally • Broad inclusion of family in diabetes education • Barriers (e.g., costs, distance, etc.) need to be addressed locally • Low literacy and health literacy

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